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A clinically guided approach for improving performance measurement for hypertension.
Michael A Steinman1, Sei J Lee, Carolyn A Peterson
1Health Services Research and Development Research Enhancement Award Program, San Francisco VA Medical Center, San Francisco, CA 94121, USA. mike.steinman@ucsf.edu
Medical Care
|May 26, 2012
Summary
Many patients have valid reasons for not meeting blood pressure (BP) targets. A new clinically guided system for BP control measurement better reflects individual patient circumstances than traditional methods.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Quality Improvement
Background:
- Traditional performance measures for blood pressure (BP) control often overlook valid reasons for patients not achieving treatment targets.
- This limitation can lead to inaccurate assessments of healthcare quality and patient outcomes.
Purpose of the Study:
- To evaluate a novel, clinically guided performance measurement system for BP control.
- To compare this system with traditional methods in a veteran population.
Main Methods:
- A structured chart review of 201 adult patients with hypertension was conducted in two VA healthcare systems.
- The novel system incorporated clinical reasoning, exempting patients when tight BP control was inappropriate or infeasible and assessing BP trends over time.
- Results were compared against traditional BP measurement approaches.
Main Results:
- The clinically guided approach exempted 30% of patients, primarily due to inadequate BP management opportunities or polypharmacy (≥4 antihypertensives).
- There was poor agreement between traditional (most recent BP) and integrated BP assessment methods (κ=0.14).
- Using the clinically guided system, only 21% of patients with a last BP ≥140/90 mm Hg were classified as having problematic BP control.
Conclusions:
- A significant number of patients have legitimate clinical reasons for not achieving strict BP control.
- The method of BP assessment and consideration of clinical exemptions substantially impact patient classification regarding BP control adequacy.
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