Abstract:
BACKGROUND:Performance measures often fail to account for legitimate reasons why patients do not achieve recommended treatment targets. METHODS:We tested a novel performance measurement system for blood pressure (BP) control that was designed to mimic clinical reasoning. This clinically guided approach focuses on (1) exempting patients for whom tight BP control may not be appropriate or feasible and (2) assessing BP over time. Trained abstractors conducted structured chart reviews of 201 adults with hypertension in 2 VA health care systems. Results were compared with traditional methods of performance measurement. RESULTS:Among 201 veterans, 183 (91%) were male, and the mean age was 71±11 years. Using the clinically guided approach, 61 patients (30%) were exempted from performance measurement. The most common reasons for exemption were inadequate opportunity to manage BP (35 patients, 17%) and the use of 4 or more antihypertensive medications (19 patients, 9%). Among patients eligible for performance measurement, there was little agreement on the presence of controlled versus uncontrolled BP when comparing the most recent BP (the traditional approach) with an integrated assessment of BP control (κ 0.14). After accounting for clinically guided exemptions and methods of BP assessment, only 15 of 72 patients (21%) whose last BP was ≥140/90 mm Hg were classified as problematic by the clinically guided approach. CONCLUSIONS:Many patients have legitimate reasons for not achieving tight BP control, and the methods used for BP assessment have marked effects on whether a patient is classified as having adequate or inadequate BP control.
journal_name
Med Carejournal_title
Medical careauthors
Steinman MA,Lee SJ,Peterson CA,Fung KZ,Goldstein MKdoi
10.1097/MLR.0b013e318245a147subject
Has Abstractpub_date
2012-05-01 00:00:00pages
399-405issue
5eissn
0025-7079issn
1537-1948pii
00005650-201205000-00007journal_volume
50pub_type
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