Patient Factors Associated With Documented Provision of JNC 7–Recommended Hypertension Care at an Academic Family Medicine Office

Article Figures & Data

Table 1. Documentation of Care Recommended By JNC 7

Criteria	Weight
Diagnosis
1. Cardiovascular risk factors	1
2. Identified blood pressure goal	1
3. BP goal was communicated to the patient, verbally or in writing	1
Pharmacology
4. Monotherapy where appropriate (stage I HTN)	2
5. Combination therapy where appropriate (stage II HTN or stage I HTN with comorbidities)	2
Follow-up
6. Absence of BP control noted whenever office BP measurements exceed 140/90 mm Hg	1
7. Lifestyle modifications discussed during at least 50% of encounters	1
Laboratory monitoring
8. Fasting lipid panel measured within past 12 months	2
9. Patients with diabetes mellitus and/or chronic kidney disease screened for urine albumin within past 12 months	2
10. Serum creatinine measured within past 12 months	2
11. Blood glucose measured within past 12 months	2
12. Hematocrit measured within past 12 months	1
13. Serum potassium measured within past 12 months	1
14. Serum calcium measured within past 12 months	1
15. EKG measured at any point in the past	2

Table 2. Eligibility Criteria

Inclusion	Age at least 21 years
	Diagnosed with hypertension
	Established patient (defined by at least 1 visit/year for the past 3 years)
	At least 3 visits in 2013
Exclusion	Evidence of hypertensive emergency
	Myocardial infarction in the past 6 months
	Heart failure
	Unstable angina
	Serious renal disease (ie, CKD stage IV and V, renal failure) or hepatic disease
	Pregnancy
	Dementia/cognitive impairment

Table 3. Documentation Scores for Individual Criteria

Criteria	Documentation Score, % (n/N)
Items evaluated once during the entire audit period
Cardiovascular risk factors	96.7 (145/150)
Identified BP goal	18.7 (28/150)
BP goal communicated to patient	10.7 (16/150)
Patient is treated with monotherapy when appropriate (stage 1 HTN)	100.0 (67/67)
Patient is treated with combination therapy when appropriate (stage 2 HTN or stage 1 HTN with comorbidities)	97.7 (83/85)
Fasting lipid profile^*	92.6 (138/149)
Patients with diabetes or CKD screened for urine albumin^*	68.8 (53/77)
Serum creatinine^*	96.7 (145/150)
Blood glucose^*	96.7 (145/150)
Hematocrit^*	69.8 (104/149)
Serum potassium^*	96.7 (145/150)
Serum calcium^*	96.7 (145/150)
EKG performed at any point	78.0 (117/150)
Items evaluated during multiple visits
Absence of BP control mentioned in progress note when applicable	88.7 (63/71)
Discussion of lifestyle modification documented for at least 50% of visits in audit period	22.0 (33/150)

↵* Measured within the past 12 months.
BP, blood pressure; CKD, chronic kidney disease; EKG, electrocardiogram; HTN, hypertension.

Table 4. Sample Descriptive Statistics and Documentation Scores

↵* Data are % (n/N) unless otherwise indicated.
↵† Data are mean (standard deviation).
↵‡ Measured by the Usual Provider Continuity Index (percentage of visits to the same provider).
SD, standard deviation.