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The Importance of EHR Quality Measures & Hypertension


Joe is 50 years old and sees a physician for a routine visit to establish care. He has no prior medical problems, but has been told his blood pressure is a bit high. He has no complaints, takes no medication, tries to eat well, but does not exercise. The only noteworthy findings from his exam are obesity and a blood pressure of 172/86 mm/Hg.1

Which Hypertension Quality Measures Count for Stage 1 2013 Meaningful Use

Which Hypertension Quality Measures Count for Stage 1 & Stage 2 Meaningful Use

Measuring & Improving Hypertension Care: A Real Impact on Your Patients

  • According to the World Health Organization: 2
    • 51% of cerebrovascular disease deaths are attributable to high systolic blood pressure,
    • 45% of ischemic heart disease deaths are attributable to high systolic blood pressure,
    • The leading cause of cardiovascular death worldwide is high blood pressure.
  • A meta-analysis of one million adults with no previous vascular disease in 61 prospective observational studies of blood pressure and mortality found that even in the general normotensive population , persistent reductions in blood pressure of just a few mmHg could avoid a large absolute number of premature deaths and disabling strokes:3
    • A 10mmHg lower usual SBP was associated with a 40% lower risk of stroke death and 30% lower risk of death from ischemic heart disease and other vascular causes throughout middle age.
    • A 2 mmHg lower usual SBP involved 10% lower stroke mortality and 7% lower mortality from ischemic heart disease and other vascular causes in middle age.
  • A 2006 cross-sectional study that evaluated blood pressure management in a random sample of 7,478 non-institutionalized adults found:4
    • 38% of men and 29% of women were unaware they had hypertension
    • Of patients who had a cardiovascular risk > 20%, but no history of CHD or stroke, only 55% percent were receiving treatment, and only 17% had their blood pressure controlled at <140/90 mm/Hg

Conclusion

By identifying and addressing Joe's hypertension, his risk of suffering a disabling stroke or even dying from cardiovascular event markedly decreases. As a result, Joe can enjoy a higher quality of life in the years ahead.

Clinical Quality Measure Information

Hypertension: Blood Pressure Management

NQF# Description Numerator Denominator Exclusions
0013 Percentage of patient visits with blood pressure measurement recorded among all patient visits for patients > 18 years of age with diagnosis of hypertension. Patients with:
  • Blood pressure measurement recorded.
Patients:
  • >18 years of age
  • Diagnosed with hypertension
  • None

Controlling High Blood Pressure

NQF# Description Numerator Denominator Exclusions
0018 Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90) Patients with:
  • Blood pressure measurement < 140/90 mm/Hg
Patients:
  • 18 < 85 years old
  • Diagnosed with hypertension
Patients with:
  • End Stage Renal Disease
  • Pregnancy
  • Admission to a non-acute inpatient setting before 12/31 of the measurement year

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.5

  1. Adapted from the following vignette, https://online.epocrates.com/u/292226/Essential+hypertension/Basics/Vignette Exit Disclaimer [online.epocrates.com]; Accessed January 31, 2012.
  2. World Health Organization, "Global Health Risks: Mortality and burden of disease attributable to selected major risks". WHO Press. Geneva, Switzerland: 2009
  3. Prospective Studies Collaboration. "Age specific relevance of usual blood pressure to vascular mortality; a meta-analysis of individual data for one million adults in 61 prospective studies". Lancet. 360 (2002): 1903-13
  4. Falaschetti, E., Chaudhury, M., Mindell, J., Poulter, N. Continued Improvement in Hypertension Management in England: Results from the health survey for England 2006. Hypertension. 53 (2009); 480-86
  5. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup - March 22, 2013

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