A new, comprehensive measure set for the diagnosis and treatment of high blood pressure (BP), was released Nov. 12 and published in the Journal of the American College of Cardiology. Developed by the ACC and the American Heart Association, the measure set is in accordance with the 2017 Hypertension Clinical Practice Guidelines.

All told, the set includes 22 new measures: six performance measures; six process quality measures; and 10 structural quality measures. Of note, performance measures are generally developed based on the highest quality of evidence; whereas quality measures may be useful for local quality improvement but are not yet appropriate for public reporting or pay-for-performance programs.

According to the authors, the new category of 10 structural quality measures were created to "evaluate the capability and capacity of various levels of the U.S. health care system to implement the 2017 Hypertension Clinical Practice Guidelines recommended strategies, such as standardized BP measurement, protocols, electronic health record surveillance, telehealth, team-based care, a single plan of care and performance measures."  In addition, the document stresses the importance of measuring atherosclerotic cardiovascular disease similar to the hypertension guidelines, noting that end users of the new performance measure set should "incorporate this risk assessment process in order to achieve successful implementation as a key component of quality improvement for patients with high BP."

"There are three major goals of this document," adds Donald E. Casey, Jr., MD, MPH, MBA, chair of the writing committee. "First, to develop new performance measures designed to evaluate the control of patients with Stage 1 high BP (130-139) in a manner identical to the current measure commonly used by the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services for Stage 2 high BP (≥ 140), separately for Stage 1 and combined with Stage 2 into a single composite measure. Second, to provide new measures intended to evaluate treatment and monitoring of patients with high BP, including the assessment of lifestyle modification (any stage), medication adherence (Stage 2 and Stage 1 with atherosclerotic cardiovascular disease risk ≥ 10 percent) and home BP monitoring (Stage 1 and Stage 2, separately and combined). Third, to provide a standardized measurement framework for comprehensive assessment of a 'care delivery unit' (rather than at the clinician or health plan levels) as a guide to designing and implementing an evidence-based system of care for patients with high BP based on the 2017 ACC/AHA High Blood Pressure Guidelines."

Moving forward, "the effective implementation of this measure set by clinicians, care teams, and health systems will lead to significant improvements in effective detection and treatment of high BP for millions of people across the U.S.," said the authors.

Keywords: Quality Improvement, Medication Adherence, Medicaid, Centers for Medicare and Medicaid Services, U.S., Reimbursement, Incentive, Medicare, Blood Pressure Monitoring, Ambulatory, Telemedicine, Electronic Health Records, Risk Assessment, Hypertension, Cardiovascular Diseases

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