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Performance Review
 

Clinical Measures for Health Center Grantee Performance Reviews –
Calendar Year 2006


Performance Measure: # 8   Activity Code(s): H 80  
Percentage of adults diagnosed with hypertension, whose blood pressure is under control.
 
Definition:
Numerator:

Number of adults (age 18 years or older) clinically diagnosed with hypertension whose most recent blood pressure, as per guidelines (see below), is less than 140/90 mmHg PLUS the number of adults clinically diagnosed with hypertension with diabetes or chronic kidney disease whose most recent blood pressure is less than 130/80 mmHg.
Denominator: Number of all adults (age 18 years of age or older) with an encounter for any reason at all during calendar year and who also have a diagnosis of hypertension.
Unit & Text: (Number of adults with controlled hypertension/ Number of clinically diagnosed with hypertension) x 100 = percent of adults with controlled hypertension.
 
National Benchmark:

HEDIS benchmarks for 2004 are

Healthy People 2010 goal is 50%.
Data Sources
and Data Issues:
 From registry or EHR/EMR if available.

If chart audit, then sample from the sample frame of persons meeting denominator criteria.

 
Background/significance of the measure:
Hypertension (high blood pressure) affects nearly one in three American adults, in the United States and is the most common primary diagnosis in America (35 million office visits as the primary diagnosis). It is a risk factor for heart disease and stroke, along with abnormal cholesterol, tobacco use, diabetes, overweight and physical inactivity. Current control rates are still far below the Healthy People 2010 goal of 50 percent; 30 percent are still unaware they have hypertension.1 A consistent blood pressure reading of 140/90 mmHg or higher is considered hypertension.

Once high blood pressure develops, it usually lasts a lifetime. The good news is that it can be treated and controlled. High blood pressure is called "the silent killer" because it usually has no symptoms. Some people may not find out they have it until they have trouble with their heart, brain, or kidneys. When high blood pressure is not found and treated, it can cause problems with these and other organs. See: http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html

Hypertension is featured prominently in the BPHC Health Disparities Collaborative:
http://www.healthdisparities.net/hdc/html/collaboratives.topics.cvd.aspx
and in HEDIS:
http://www.ncqa.org/Docs/SOHCQ_2005.pdf (p. 37)

The main clinical practice guideline for this measure is: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) NIH, NHLBI; Dec 2003; see:
http://www.nhlbi.nih.gov/guidelines/hypertension/

Measurement of blood pressure:

Guidelines:
An accurate clinical diagnosis of hypertension “is based upon the average of two or more properly measured, seated blood pressure readings on each of two or more office visits” 2

The auscultatory method of BP measurement with a properly calibrated and validated instrument should be used. Persons should be seated quietly for at least 5 minutes in a chair (rather than on an exam table), feet on the floor; and arm supported at heart level.

Measurement of BP in the standing position is indicated periodically, especially in those at risk for postural hypotension. An appropriate-sized cuff (cuff bladder encircling at least 80 percent of the upper arm) should be used to ensure accuracy. At least two measurements should be made. Systolic blood pressure is the point at which the first of two or more sounds is heard (phase 1), and diastolic blood pressure is the point before the disappearance of sounds (phase 5). Screening for hypertension using automated machines by medical assistants and others is common practice. However, clinical diagnosis of hypertension should be made based upon the above [auscultatory] guidelines.
1Ibid, page 4.
2 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure(JNC-7) NIH, NHLBI; Dec 2003; page 2; see:
http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf

This measure examines the continuity of care at health center grantees for hypertension screening and blood pressure control, including provider education and adherence, patient outreach and health education, follow up, and appointment systems for the existing screening protocol.