Prenatal care in the first trimester: misleading findings from HEDIS

Objective. To understand factors influencing Health Plan Employer Data and Information Set (HEDIS(R)) rates for the measure 'Prenaral care in the firs t trimester'. Design. Telephone sun ey of a retrospective cohort of women with a live bir th. Medical record review of a sample of both responders and non-responders to the telephone survey. Detailed review of HEDIS data collection procedur es. Setting. A managed care plan in California. Study participants. Women aged 18-49 years at date of delivery who delivere d a live birth from 1 October 1995 through 31 March 1996, and who were cont inuously enrolled in a California managed care plan for 12 months prior to delivery (telephone survey n=1185; medical record review, n=465). Results. Of the women participating in the telephone survey: 95% indicated chat their first prenatal visit occurred during the first 3 months of pregn ancy. Using HEDIS 3.0 standards, a review of medical records for a sample o f these women indicated that 94% of the women initiated care during the fir st trimester. These results contrasted sharply with 1995 and 1996 HEDIS rat es of 64% and 75%, respectively Conclusion. An investigation of the discrepancy between HEDIS fates and rat es from both telephone sun eg and medical record review led to the finding that the low HEDIS rates were due nor to a true low rate of early care, but to data collection problems, including difficulty obtaining medical record s. Potential solutions involving health plan activities, revisions tu the o fficial HEDIS process and revised reporting of results are proposed.