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Concordance Between Common Hypertension Control Algorithms in Electronic Medical Record Data

Victoria M Nielsen1, Amy Bettano2, Mark Josephson3

  • 1Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108.

Preventing Chronic Disease
|September 15, 2017
PubMed

Insights

Blood pressure control estimates vary significantly based on the guidelines used. Discrepancies between National Quality Forum (NQF) and Joint National Committee (JNC) thresholds can lead to differences up to 16.1%.

Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Clinical Quality Measurement

Background:

  • Quality improvement metrics and treatment guidelines are crucial for research, care evaluation, and population health assessment.
  • Alignment between these metrics and guidelines is ideal for consistent healthcare evaluation.
  • Existing discrepancies can impact the accuracy of healthcare quality assessments.

Purpose of the Study:

  • To analyze the variation in blood pressure control estimates using thresholds from the National Quality Forum 0018 (NQF 0018) and Joint National Committee (JNC) guidelines.
  • To quantify the differences in hypertension management assessment based on these distinct guideline thresholds.
  • To highlight the implications of guideline discrepancies on quality improvement metrics.

Main Methods:

  • Utilized electronic medical record (EMR) data from a cohort of patients with hypertension.
  • Calculated blood pressure control estimates using two different threshold sets: NQF 0018 and JNC treatment guidelines.
  • Analyzed and compared the percentage of patients with controlled blood pressure according to each guideline.

Main Results:

  • A notable variation in blood pressure control estimates was observed between the NQF 0018 and JNC guidelines.
  • The percentage of patients with controlled blood pressure differed by as much as 16.1 percentage points depending on the guideline used.
  • This variance underscores the impact of differing threshold definitions on quality metrics.

Conclusions:

  • Discrepancies in blood pressure thresholds between quality improvement metrics and treatment guidelines lead to significant variations in patient care estimates.
  • Careful selection of treatment guidance and quality metrics is essential to ensure accurate assessment of hypertension control and population health.
  • Future efforts should focus on harmonizing these guidelines to improve consistency in healthcare quality evaluation.

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