Prenatal care in the first trimester: misleading findings from HEDIS. Health Plan Employer Data and Information Set.

Abstract

To understand factors influencing Health Plan Employer Data and Information Set (HEDIS) rates for the measure 'Prenatal care in the first trimester'. Telephone survey of a retrospective cohort of women with a live birth. Medical record review of a sample of both responders and non-responders to the telephone survey. Detailed review of HEDIS data collection procedures. A managed care plan in California. Women aged 18-49 years at date of delivery, who delivered a live birth from 1 October 1995 through 31 March 1996, and who were continuously enrolled in a California managed care plan for 12 months prior to delivery (telephone survey, n= 1,185; medical record review, n= 465). Of the women participating in the telephone survey, 95% indicated that their first prenatal visit occurred during the first 3 months of pregnancy. Using HEDIS 3.0 standards, a review of medical records for a sample of these women indicated that 94% of the women initiated care during the first trimester. These results contrasted sharply with 1995 and 1996 HEDIS rates of 64% and 75%, respectively. An investigation of the discrepancy between HEDIS rates and rates from both telephone survey and medical record review led to the finding that the low HEDIS rates were due not to a true low rate of early care, but to data collection problems, including difficulty obtaining medical records. Potential solutions involving health plan activities, revisions to the official HEDIS process and revised reporting of results are proposed.