Failure to correctly diagnose and control high blood pressure can put people at increased risk for cardiovascular disease and stroke. Physicians, care teams and health systems that properly implement three new sets of quality measures can show how they are making strides to effectively detect and treat high BP for millions of people, says a recent report.
The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help manage their patients’ high BP. These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and the AHA.
The report was written by the ACC/AHA Performance Measures Writing Committee for High Blood Pressure, which includes Gregory Wozniak, PhD, director of outcomes analytics in Improving Health Outcomes at the AMA. The committee was charged with developing new measures for the diagnosis and management of adults with high blood pressure in accordance with the 2017 ACC/AHA Hypertension Clinical Practice Guideline.
“The guidelines have been revised significantly. The new guidelines have new categories and new terminology for defining stage 1 and stage 2 hypertension and elevated blood pressure. The new measures match up to those new classifications,” said Wozniak. “The new measures also add new emphasis on promoting lifestyle modification, on assessing and promoting medication adherence, and on correct measurement of BP by individuals at home, as recommended in the 2017 Hypertension Clinical Practice Guidelines.”
“The measures aren't guidelines, but they're a means to activate guidelines and get guidelines into practice,” said Wozniak, noting that it often takes a decade or more for evidence-based guidelines to become widely implemented in practice. “The measures are meant to simplify the guidelines so that the recommendations in those guidelines become more actionable.”
There are 22 new measures: six performance measures, six process quality measures and 10 structural quality measures.
Wozniak describes performance measures as most applicable for payment programs. These are designed for use in accountability in national quality payment and reporting programs run by the Centers for Medicare & Medicaid Services or commercial payers.
There are two new blood pressure control measures, one for patients with stage 2 hypertension and a second for patients having stage 1 hypertension, both with a more aggressive BP control threshold (systolic blood pressure of greater than 130). There also are lifestyle modification and home blood pressure monitoring performance measures for patients with stage 2 hypertension.
Process quality measures
There also are new process quality measures. These are more aligned with quality improvement efforts and initiatives, said Wozniak. Process quality measures are designed to support initiatives and activities at the national or microsystem levels.
The quality measures include measures for home blood pressure monitoring and medication adherence for stage 1 and stage 2 high blood pressure patients. In addition, if an adult patient was diagnosed with elevated BP, or with stage 1 or stage 2 hypertension there should be documentation showing that a discussion about intensive lifestyle modification.
“These are systemwide health care delivery measures that will be implemented at a health care organization or delivery system level that are general recommendations that should directly improve blood pressure control, but also improve quality of care,” said Wozniak.
Structural measures are designed to evaluate the capability and capacity of various levels of the U.S. health care system to implement recommended strategies from the guidelines. This can include standardized protocols, electronic health record surveillance, telehealth, team-based care, a single plan of care, and the adoption of performance measurement. It is intended for qualitative evaluation of process and infrastructure for these strategies at all levels—from solo and small physician offices to health care systems.
This measure set is where you will find specific approaches for patients with high BP including:
- Diagnosis, assessment and accurate measurement.
- A patient-centered approach for controlling high blood pressure.
- Implementation of a system of care.
- Use of performance measures to improve care.
Target: BP offers annual, recurring gold-level recognition for all participating sites that achieve hypertension control rates of 70% or higher among their adult patient population, and participation level recognition for those sites that prioritize improving BP control each year and submit data. In 2019, more than 1,100 organizations were recognized for their efforts focusing on BP control within the populations they serve.