The National Committee for Quality Assurance (NCQA), Committee on Performance Measurement (CPM), will include performance measures in its new guide, HEDIS 3.0, to review adolescent immunization status, and is reviewing measures for high-risk and older adults to be vaccinated against influenza. HEDIS 3.0 is the latest version of the Health Plan Employer Data and Information Set which managed care plans use to measure performance.

A performance measure for pneumococcal vaccine for all persons 65 years of age and older was not included. NCQA also did not include a measure for all adults to be protected against tetanus and diphtheria with a Td booster every 10 years. Both vaccines have been recommended for adults by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP).

Last year, the National Coalition for Adult Immunization (NCAI) recommended that NCQA include vaccine-specific and combined immunization rates for adults for influenza, pneumococcal pneumonia, and Td immunization. Hepatitis B, varicella, and Td vaccinations for adolescents were not included in the 1996 reporting. However, they will be phased in and required in 1997. "More than 50 percent of NCAI members have endorsed the recent recommendation of the ACIP for an adolescent immunization visit at ages 11-12," says Gregory A. Poland, MD, chair of the NCAI Steering Committee. "The inclusion of this measure in HEDIS 3.0 definitely will help boost the Healthy People 2000 goal to increase to 90 percent the proportion of children up to age 12 who are fully immunized."

CPM determined that the measure, "Flu Shots for High-Risk Adults," needed more testing in an effort to better evaluate various operational issues, such as how to identify specific high-risk populations consistently. According to Evan Sands from NCQA, one reason for moving the measure to the testing set is that the ICD-9 codes used to identify the high-risk patients are either not used or used inconsistently.

"Thus for the current year, many plans would likely not be able to do the measure at all," says Mr. Sands. "Among those who do, the comparability would be seriously compromised. Given some lead time and a heads up,' we are confident plans will clean up their coding enough to do the measure."

In addition, as a result of a study conducted by the Peer Review Organization in the State of Washington, the "Flu Shots for Older Adults" measurement was turned into a survey measure for the present time. CPM instituted this change by stating that health plans should collect the information for this measure using patient survey data rather than administrative or medical records. Flu shots are often provided outside the health plan (i.e., flu clinics), and relying on plan records may lead to underreporting. The data will be collected in 1997 and be reported at the end of the year.

Despite these changes and challenges, those who use HEDIS 3.0 should not dismiss the flu shot measures. "The measures are part of HEDIS 3.0 and, pending resolution of the difficulties involved, will become part of the reporting set," reports Mr. Sands.

HEDIS 3.0 is available in four volumes from NCQA. Volume 1 provides background on what is in HEDIS and an explanation of why the measures are clinically important and of value to purchasers and consumers. Volume 2 explains how to collect data for and calculate each reporting set measure. It also includes a summary of changes for each measure brought forward from HEDIS 2.5 and Medicaid HEDIS. Volume 3 provides a member survey which measures satisfaction with a variety of health plan dimensions. It includes the HEDIS 3.0 member survey instrument and protocol for sampling and administration. Volume 4 identifies the information management changes required to allow for a more complete and comprehensive assessment of health plan performance.

For a brochure order form, call (800) 839-6487.

Entry is limited to the first 100 people to register. Applications should be submitted no later than September 2. For an application, call NFID at (301) 656-0003 or e-mail your request to nfid@aol.com.

To receive a copy of the campaign kit brochure and order form, write to the above address, fax NCAI at (301) 907-0878, or e-mail NCAI at adultimm@aol.com.