Сақтықпен қамтамасыз ету деректері жиынтығы (HEDIS) және денсаулық сақтау сапасын бағалау жүйесі

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. Although not originally intended for trending, HEDIS results are increasingly used to track year to year performance. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare Advantage. HEDIS was originally titled the "HMO Employer Data and Information Set" as of version 1.0 of 1991. In 1993, Version 2.0 of HEDIS was known as the "Health Plan Employer Data and Information Set". Version 3.0 of HEDIS was released in 1997. In current usage, the "reporting year" after the term "HEDIS" is one year following the year reflected in the data; for example, the "HEDIS 2009" reports, available in June 2009, contain analyses of data collected from "measurement year" January–December 2008.

Most HEDIS data is collected through surveys, medical charts and insurance claims for hospitalizations, medical office visits and procedures. Survey measures must be conducted by an NCQA approved external survey organization. Clinical measures use the administrative or hybrid data collection methodology, as specified by NCQA. Administrative data are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies and labs. For example, a measure titled Childhood Immunization Status requires health plans to identify 2 year old children who have been enrolled for at least a year. The plans report the percentage of children who received specified immunizations. Plans may collect data for this measure by reviewing insurance claims or automated immunization records, but this method will not include immunizations received at community clinics that do not submit insurance claims. For this measure, plans are allowed to select a random sample of the population and supplement claims data with data from medical records. By doing so, plans may identify additional immunizations and report more favorable and accurate rates. However, the hybrid method is more costly, time consuming and requires nurses or medical record reviewers who are authorized to review confidential medical records. As of 2019, NCQA is transitioning data collection to a digital process that uses existing electronic data sources rather than surveys and manual data collection. The first six measures available for HEDIS Electronic Clinical Data System (ECDS) reporting include some related to depression, unhealthy alcohol use, and immunization status.

HEDIS results must be audited by an NCQA approved auditing firm for public reporting. NCQA has an on line reporting tool called Quality Compass that is available for a fee of several thousand dollars. It provides detailed data on all measures and is intended for employers, consultants and insurance brokers who purchase health insurance for groups. NCQA's web site includes a summary of HEDIS results by health plan. NCQA also collaborates annually with U. S. News & World Report to rank HMOs using an index that combines many HEDIS measures and accreditation status. The "Best Health Plans" list is published in the magazine in October and is available on the magazine's web site. Other local business organizations, governmental agencies and media report HEDIS results, usually when they are released in the fall.