eMeasure Title Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
eMeasure Identifier
(Measure Authoring Tool)
22 eMeasure Version number 1
NQF Number Not Applicable GUID 9a033a94-3d9b-11e1-8634-00237d5bf174
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Centers for Medicare & Medicaid Services
Measure Developer Quality Insights of Pennsylvania
Endorsed By None
Description
Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated
Copyright
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights of Pennsylvania disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications.

CPT (R) contained in the Measure specifications is copyright 2007-2011 American Medical Association. 

LOINC (R) copyright 2004-2011 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2011 International Health Terminology Standards Development Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Disclaimer
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
This measure assesses the percentage of patients aged 18 and older without known hypertension who were screened for high blood pressure. Hypertension is a prevalent condition that contributes to important adverse health outcomes, including premature death, heart attack, renal insufficiency and stroke. The United States Preventive Services Task Force (USPSTF, 2007) found good evidence that blood pressure measurement can indentify adults at increased risk for cardiovascular disease from high blood pressure. The relationship between systolic blood pressure and diastolic blood pressure and cardiovascular risk is continuous and graded. The actual level of blood pressure elevation should not be the sole factor in determining treatment. Clinicians should consider the patient’s overall cardiovascular risk profile, including smoking, diabetes, abnormal blood lipid values, age, sex, sedentary lifestyle, and obesity, when making treatment decisions. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends screening every 2 years for patients with blood pressure less than 120/80 mmHg and every year for patients with systolic blood pressure of 120 to 139 mmHg or diastolic blood pressure of 80 to 90 mmHg.

Appropriate follow-up after blood pressure measurement is a pivotal component in preventing the progression of hypertension and the development of heart disease. Detection of marginally or fully elevated blood pressure by a specialty clinician warrants referral to a provider familiar with the management of hypertension and prehypertension.  Lifestyle modifications have demonstrated effectiveness in lowering blood pressure (JNC 7, 2003).  The synergistic effect of several lifestyle modifications results in greater benefits than a single modification alone. Baseline diagnostic/laboratory testing establishes if a co-existing underlying condition is the etiology of hypertension and evaluates if end organ damage from hypertension has already occurred. Landmark trials such as ALLHAT have repeatedly proven the efficacy of pharmacologic therapy to control blood pressure and reduce the complications of hypertension.  Follow-up intervals based on blood pressure control have been established by the JNC 7 and the USPSTF.
Clinical Recommendation Statement
The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation.
Improvement Notation
Higher score indicates better quality.
Reference
U.S. Preventive Services Task Force (USPSTF) (2007). Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine; 147(11):783-6
Reference
U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute & National High Blood Pressure Education Program (2003). The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). NIH Publication No. 03-5233
Definition
Blood Pressure (BP) Classification: 
BP is defined by four (4) BP reading classifications: Normal, Pre-Hypertensive, First Hypertensive, and Second Hypertensive Readings

Recommended BP Follow-Up: 
The current Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) recommends BP screening intervals, lifestyle modifications and interventions based on BP Classification of the current BP reading as listed in the “Recommended Blood Pressure Follow-Up Interventions” listed below

Lifestyle Modifications: 
The current JNC report outlines lifestyle modifications which must include one or more of the following as indicated:
•  Weight Reduction
•  DASH Eating Plan 
•  Dietary Sodium Restriction
•  Increased Physical Activity
•  Moderation in ETOH Consumption

Second Hypertensive Reading: 
Requires both a BP reading of Systolic BP >= 140 mmHg OR Diastolic BP >= 90 mmHg during the current encounter AND a most recent BP reading within the last 12 months Systolic BP >= 140 mmHg OR Diastolic BP >= 90 mmHg

Second Hypertensive Reading BP Interventions:  
The current JNC report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated:
•  Anti-Hypertensive Pharmacologic Therapy 
•  Laboratory Tests 
•  Electrocardiogram (ECG)

Recommended Blood Pressure Follow-Up Interventions:
•  Normal BP: No follow-up required for Systolic BP < 120 mmHg AND Diastolic BP <80 mmHg
•  Pre-Hypertensive BP: Rescreen every year with systolic BP of 120-139 mmHg OR diastolic BP of 80-89 mmHg AND follow-up with lifestyle recommendations OR referral to Alternative/Primary Care Provider
•  First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg rescreen > 1 day and < 4 weeks follow-up  AND lifestyle recommendations OR referral to Alternative/Primary Care Provider  
•  Second Hypertensive BP Reading: Patients with second elevated reading of  systolic BP >=140 mmHg OR diastolic BP >= 90 mmHg and follow-up with lifestyle recommendations  AND one or more of the Second Hypertensive Reading Interventions
Guidance
Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, use the lowest systolic and lowest diastolic blood pressure on that date as the representative blood pressure.

Providers who report the measure must perform the blood pressure screening at the time of a qualifying visit by an eligible professional and may not obtain measurements from external sources. 

The documented follow up plan must be related to the current BP reading as indicated, example: “Patient referred to primary care provider for BP management.”
Transmission Format
TBD
Initial Patient Population
Percentage of patients aged 18 years and older before the start of the measurement period
Denominator
Equals Initial Patient Population
Denominator Exclusions
Patient has an active diagnosis of hypertension
Numerator
Patients who were screened for high blood pressure AND a recommended follow-up plan is documented as indicated if the blood pressure is pre-hypertensive or hypertensive
Numerator Exclusions
Not Applicable.
Denominator Exceptions
Patient Reason(s): 
Patient refuses to participate

OR

Medical Reason(s):
Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status.  This may include but is not limited to severely elevated BP when immediate medical treatment is indicated.
Measure Population
Not Applicable.
Measure Observations
Not Applicable.
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 Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
Preventive Care and Screening