Article Figures & Data
Tables
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 BP, blood pressure; EKG, electrocardiogram; HTN, hypertension.
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 CKD, chronic kidney disease.
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.
Continuous Data Values* Documentation Scores (%)† Age (years), mean (SD) 64.7 (12.7) — Years in practice, mean (SD) 8.3 (4.6) — Visits in 2013, mean (SD) 4.5 (2.0) — Continuity of care, mean (SD)‡ 0.8 (0.2) — Race/ethnicity Non-Hispanic white 33.3 (50/150) 76.9 (14.5) Non-Hispanic black 33.3 (50/150) 77.9 (12.5) Hispanic (any race) 33.3 (50/150) 80.1 (9.7) Sex Female 55.3 (83/150) 76.4 (15.0) Male 44.7 (67/150) 80.7 (7.4) Marital Status Single 18.2 (27/148) 72.4 (19.5) Married 62.8 (93/148) 80.4 (7.3) Divorced/widowed 18.9 (28/148) 76.4 (15.6) Insurance Private 39.3 (59/150) 77.4 (14.9) Medicare 31.3 (47/150) 79.9 (11.2) Medicare Advantage 21.3 (32/150) 79.6 (7.3) Medicaid 8.0 (12/150) 72.8 (13.6)