A Clinically Guided Approach for Improving Performance Measurement for Hypertension

Bibliographic Data

ID9102860
AuthorsMichael A Steinman (0000-0002-9564-9480, San Francisco VA Medical Center, corresponding author), Sei J Lee (0000-0001-7864-5341, University of California, San Francisco, corresponding author), Carolyn A Peterson (University of California, San Francisco, corresponding author), Kathy Z Fung, Kathy Fung (University of California, San Francisco, corresponding author), Mary K Goldstein (0000-0001-7256-5746, VA Palo Alto Health Care System)
Year2012
Volume50
Issue5
Pages399-405
Publication date2012-05-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e318245a147
PMID22627680
PMCIDPMC3368331
OpenAlexW2081874482
LanguageEN
References cited20

BACKGROUND: Performance measures often fail to account for legitimate reasons why patients do not achieve recommended treatment targets. METHODS: We tested a novel performance measurement system for blood pressure (BP) control that was designed to mimic clinical reasoning. This clinically guided approach focuses on (1) exempting patients for whom tight BP control may not be appropriate or feasible and (2) assessing BP over time. Trained abstractors conducted structured chart reviews of 201 adults with hypertension in 2 VA health care systems. Results were compared with traditional methods of performance measurement. RESULTS: Among 201 veterans, 183 (91%) were male, and the mean age was 71±11 years. Using the clinically guided approach, 61 patients (30%) were exempted from performance measurement. The most common reasons for exemption were inadequate opportunity to manage BP (35 patients, 17%) and the use of 4 or more antihypertensive medications (19 patients, 9%). Among patients eligible for performance measurement, there was little agreement on the presence of controlled versus uncontrolled BP when comparing the most recent BP (the traditional approach) with an integrated assessment of BP control (κ 0.14). After accounting for clinically guided exemptions and methods of BP assessment, only 15 of 72 patients (21%) whose last BP was ≥140/90 mm Hg were classified as problematic by the clinically guided approach. CONCLUSIONS: Many patients have legitimate reasons for not achieving tight BP control, and the methods used for BP assessment have marked effects on whether a patient is classified as having adequate or inadequate BP control

MEDLINE · Blood Pressure and Hypertension Studies · Health Systems, Economic Evaluations, Quality of Life · Internal Medicine · Medicine · Primary Care and Health Outcomes