National Committee for Quality Assurance Incorporates AHRQ Research Into Beta Blocker Therapy Indicator

Comparative Effectiveness
November 2005

As a result of research findings initially provided by the Center for Education and Research on Therapeutics (CERTs) at Duke University Medical Center and subsequent research by the Council for Affordable Quality Healthcare (CAQH), the National Committee for Quality Assurance (NCQA) has incorporated a new indicator on long-term patient adherence to beta blocker therapy in the Health Plan Employer Data Information Set (HEDIS™). HEDIS is a standardized tool used by over 400 health plans to measure and report their performance.

Health plans use the new beta blocker measure in two ways: first, they report their scores on the measure to NCQA, employers, states, and others. Second, the plans use the measure to assess their performance and focus their quality improvement efforts.

In early 2002, CAQH staff were preparing a cardiovascular quality initiative, and they approached CERTs investigators at Duke University Medical Center for guidance on developing it. Previous AHRQ-supported research at Duke in patients with chronic coronary heart disease (CHD) had shown low rates of long-term adherence to beta blocker therapy, a class of drugs that improve survival and decrease recurrent heart attacks. Specifically, the CERTs research had demonstrated that in the year 2000, only about 50 percent of patients with chronic CHD were taking beta blockers.

In contrast, HEDIS data from the same year indicated that over 90 percent of patients who had a heart attack were discharged from the hospital on beta blockers. This discrepancy led to concern that heart attack patients may not maintain beta blocker therapy long-term.

To explore this issue further among CAQH's member health plans, CAQH conducted its own research based on claims data from member plans. CAQH's data supported the CERTs findings about low levels of long-term patient adherence to beta blocker therapy. In an independent analysis of CAQH's data, Duke investigators reported that only 45 percent of patients regularly took beta blockers during the first full year after a heart attack.

After reviewing these data with CAQH, NCQA subsequently elected to add a longer-range patient adherence measure for beta blockers to HEDIS, specifically looking at adherence 180 days after hospital discharge. This new measure will help focus all reporting health plans on this important quality area.

NCQA has been accrediting managed care organizations since 1991, in response to the need for standardized information about the quality of these organizations.

CAQH is a not-for-profit alliance of health plans and networks. It promotes collaborative initiatives to help make health care more affordable, to share knowledge to improve the quality of health care, and to make administration easier for physicians and their patients.

Impact Case Study Identifier: 
AHRQ Product(s): CERTs
Topics(s): Beta Blockers, Quality
Geographic Location: National
Implementer: National Committee for Quality Assurance
Date: 11/01/2005

Kramer JM, Fetterolf D, Charde JP, Snyder R, Hammill B, DeLong E, Hoffman BS, Arrington RL, Allen LaPointe N, Peterson ED. National evaluation of adherence to beta blocker therapy for one year after acute myocardial infarction in patients with commercial health insurance. Circulation. 2004: 109(20): e291.
Available at: Accessed June 9, 2004. Duke investigators were supported in part by AHRQ Grant No. HS010548.

Page last reviewed October 2014