eMeasure Title

Hypertension: Improvement in Blood Pressure

eMeasure Identifier (Measure Authoring Tool) 65 eMeasure Version number 7.1.000
NQF Number Not Applicable GUID 1d8363ce-a529-490b-8c98-9b54aa75da06
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Developer National Committee for Quality Assurance
Endorsed By None
Description
Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period
Copyright
This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved.

The American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com.
Disclaimer
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring Proportion
Measure Type Outcome
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Hypertension, or high blood pressure, is a very common and dangerous condition that increases risk for heart disease and stroke, two of the leading causes of death for Americans (Farley et al., 2010). Compared with other dietary, lifestyle, and metabolic risk factors, high blood pressure is the leading cause of death in women and the second-leading cause of death in men, behind smoking (Danaei et al., 2011). Approximately 1 in 3 U.S. adults, or about 70 million people, have high blood pressure but only about half (52%) of these people have their high blood pressure under control. Additionally, data from NHANES 2011 to 2012 found that 17.2% of U.S. adults are not aware they have hypertension (Nwankwo et al., 2013). Projections show that by 2030, approximately 41.4% of US adults will have hypertension, an increase of 8.4% from 2012 estimates (Heidenreich et al., 2011).

The estimated direct and indirect cost of high blood pressure for 2011 is $46.4 billion. This total includes direct costs such as the cost of physicians and other health professionals, hospital services, prescribed medications and home health care, as well as indirect costs due to loss of productivity from premature mortality (Mozaffarian et al., 2015). Projections show that by 2030, the total cost of high blood pressure could increase to an estimated $274 billion (Heidenreich et al., 2011).

Better control of blood pressure has been shown to significantly reduce the probability that undesirable and costly outcomes will occur. In clinical trials, antihypertensive therapy has been associated with reductions in stroke incidence (35-40%), myocardial infarction (20-25%) and heart failure (>50%) (Chobanian et al., 2003). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.
Clinical Recommendation Statement
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): Treating systolic blood pressure and diastolic blood pressure to targets that are <140/90 mmHg is associated with a decrease in cardiovascular disease complications
Improvement Notation
A higher score indicates better quality
Reference
Centers for Disease Control and Prevention (CDC). Prevalence of self-reported cardiovascular disease among persons aged >=35 years with diabetes: United States, 1997-2005. MMWR Morb Mortal Wkly Rep. 2007;56:1129-1132.
Reference
Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2572.
Reference
Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, Ezzati M. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors [published correction appears in PLoS Med. 2011;8. doi: 10.1371/annotation/0ef47acd-9dcc-4296-a897-872d182cde57]. PLoS Med. 2009;6:e1000058.
Reference
Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38:600-9.
Reference
Heidenreich, P.A., J.G. Trogdon, O.A. Khavjou, et al. 2011. "Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association." Circulation.123:933-944.
Reference
Mozaffarian, D., E.J. Benjamin, A.S. Go, et al. 2015. "Heart disease and stroke statistics-2015 update: a report from the American Heart Association." Circulation. 131:e29-e322. doi: 10.1161/CIR.0000000000000152
Reference
Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the US: National Health and Nutrition Examination Survey, 2011-2012. NCHS Data Brief, No. 133. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2013.
Reference
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No.03 - 5233 December 2003
Definition
Adequate control: a systolic blood pressure < 140 mmHg. 

Uncontrolled blood pressure: a systolic blood pressure >= 140 mmHg.

Uncontrolled baseline blood pressure: systolic blood pressure >= 140 mmHg that is taken during the first outpatient encounter of the measurement year in which the patient has an active diagnosis of hypertension. This must occur during the first six months of the year. If the patient with hypertension has uncontrolled blood pressure during the first outpatient encounter of the measurement year, then include the patient in the initial patient population of the measure.

Follow-up blood pressure: systolic blood pressure taken during the first outpatient encounter during the measurement year that occurs at least six months after the baseline blood pressure.

Improvement in blood pressure: the follow-up blood pressure is at least 10 mmHg less than the baseline systolic blood pressure.
Guidance
Blood pressure readings must be taken while the patient is sitting. If multiple measurements occur on the same date, the last systolic and diastolic readings should be used.

"Occurrence A of Physical Exam, Performed: Systolic Blood Pressure (result)" represents the baseline blood pressure, which must occur prior to "Occurrence B of Physical Exam, Performed: Systolic Blood Pressure (result)", which represents the follow-up blood pressure.

To calculate the "Physical Exam, Performed: Delta systolic blood pressure (result)" data element, subtract the value of "Occurrence B of Physical Exam, Performed: Systolic Blood Pressure (result)" from the value of "Occurrence A of Physical Exam, Performed: Systolic Blood Pressure (result)". 

The data element "Physical Exam, Performed: Delta systolic blood pressure (result)" is intended to represent the result of the mathematic comparison between systolic blood pressures taken during two separate visits. This is a calculation artifact, and there's no requirement to document the delta data element in the medical record.
Transmission Format
TBD
Initial Population
All patients aged 18-85 years of age, who had at least one outpatient visit in the first six months of the measurement year, who have a diagnosis of essential hypertension documented during that outpatient visit, and who have uncontrolled baseline blood pressure at the time of that visit
Denominator
Equals Initial Population
Denominator Exclusions
Exclude from the denominator all patients with evidence of end-stage renal disease (ESRD) on or prior to December 31 of the measurement year. Documentation of dialysis or kidney transplant also meets the criteria for evidence of ESRD.

Exclude from the denominator all patients with a diagnosis of pregnancy during the measurement year.

Exclude patients who were in hospice care during the measurement year.
Numerator
Patients whose follow-up blood pressure is at least 10 mmHg less than their baseline blood pressure or is adequately controlled.

If a follow-up blood pressure reading is not recorded during the measurement year, the patient's blood pressure is assumed "not improved."
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
Not Applicable