1. Screening Rates Before and After the Introduction of the Chlamydia HEDIS Measure in a Managed Care Organization GR Burstein 1, MA Snyder 2, D Conley 2, DR Newman 1, CM Walsh 1, G Tao 1, K Irwin 1 1 Centers for Disease Control and Prevention 2 Kaiser Permanente Mid-Atlantic States

2. Background

3. 3 HEDIS Health Plan Employer Data and Information Set (HEDIS) is a a tool used to measure managed care organization (MCO) performance in key areas. HEDIS is supported by the National Center for Quality Assurance (NCQA) independent non-profit organization whose mission is to improve US health care quality Almost 90% of health plans measure their performance using HEDIS.

4. In 2000, a new HEDIS performance measure was introduced to monitor the proportion of sexually active 15-26 year-old females screened annually for chlamydia.

5. 5 Objectives To determine changes after introduction of the HEDIS measure in a large MCO in: 1)chlamydia screening policies 2)chlamydia testing practices 3)chlamydia positivity rates

6. 6 Methods We reviewed electronic medical records of a large, not-for-profit MCO for 15-26 year-old females who were classified as sexually active according to administrative data elements specified by HEDIS Endocervical chlamydia tests (DNA probe; GenProbe, San Diego, CA) performed during 1998-2001

7. 7 Methods We used chi-square testing to compare chlamydia screening rates and positive tests for the 2 years before (1998-9) and after (2000-1) the introduction of the chlamydia HEDIS measure. We queried MCO departmental chiefs about practice changes implemented to meet the new HEDIS measure.

8. 8 Kaiser Permanente Mid-Atlantic States Employer-based, not-for-profit MCO plan serves primary working people and their dependents no Medicaid beneficiaries Serves diverse population 21 clinics in Baltimore City, Washington DC, Maryland and Northern Virginia suburbs Offers unrestricted access to OB-GYN services Provides confidential adolescent reproductive health care services Explanation of Benefits not sent home which avoids breech of confidentiality about sexual activity/sexual health services Require adolescent permission to release confidential information

9. Results

10. 10 15-26 Year Old Females Who Were MCO Members, Members Classified as Sexually Active (SA) by HEDIS Criteria and Tested for Chlamydia trachomatis, 1998-2001. Year 15-26 yo ♀ Members n SA 15-26 yo ♀ Members n (%) SA 15-26 yo ♀ Members CT Tested n (%) 1998-971927 37438 (52) 20571 (55) 2000-171569 37237 (52) 26801 (72)* *p<0.0001

11. 11 Changes in MCO Chlamydia Screening Policies by Specialty OB-GYN instituted policy of collecting a chlamydia test at the same time as a Pap test on 15-26 y.o. females policy operationalized by nursing assistants automatically placing a chlamydia collection swab next to Pap collection materials Other primary care specialties Internal Medicine and Family Practice advised providers to perform chlamydia tests with Pap smears on 15-26 y.o. females policy merely articulated but was not operationalized within their practices Pediatrics offered providers adolescent heath care training

12. 12 Type of Specialty Care Received by Adolescent Female Members 15-26 Years Old Classified as Sexually Active by HEDIS Criteria, 1998-2001 Year 1  Care OB-GYN Both 1  Care & OB-GYN 1998-9 N=37438 18%14%66% 2000-1 N=37237 19%13%65% Type of Specialty Care

13. 13 Proportion of Sexually Active 15-26 Year Old Female MCO Members Tested for Chlamydia in Specialty Departments, 1998-2001 Year 1  Care OB-GYN 1  Care OB-GYN Both 1  Care & OB-GYN 1998-9 30% N=6898 57% N=5127 4% N=24731 49% N=24731 9% N=24731 2000-1 32% N=7042 81%* N=5014 3%* N=24362 71%* N=24362 10% N=24362 % of SA ♀ MCO Members CT Tested Who Were Seen in Single Specialty Care Visits Both Primary Care & OB-GYN Visits *p<0.0001

14. 14 Year CT Tests with Paps CT Tests with Pregnancy Test CT Tests with Contraception Rx 1998-9 64% N=28953 66% N=16813 53% N=22265 2000-1 87%* N=28341 75%* N=17140 74%* N=23166 Chlamydia Tests Performed Among Female 15-26 Year Old MCO Members Who Received Paps, Pregnancy Tests, or Filled Contraceptive Prescriptions, 1998-2001 *p<0.00001

15. 15 Proportion of Positive Chlamydia trachomatis tests Among MCO Female Members 15-26 Years Old, 1998-2001 Year 15-19 yo n (%) 20-26 yo n (%) 1998-9 974/7623 (12.8%) 707/12948 (5.5%) 2000-1* 996/8906 (11.2%) 856/17895 (4.8%) Proportion of Positive C. trachomatis Tests *171 more cases detected

16. 16 Conclusions Following HEDIS measure introduction in this MCO, % of sexually active 15-26 year- old females tested for chlamydia increased overall with little change in the % of positive tests Most of the increase resulted from the new OB-GYN policy of performing chlamydia screening with routine Pap tests

17. 17 Implications for Programs & Policy Simple systems changes and access to OB-GYN providers can improve chlamydia screening rates and detect a significant number of asymptomatic infections in an MCO Operationalizing policy in the health system is key to change