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Research ArticleOriginal Research

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

Ajay Koti and Richard G. Roetzheim
The Journal of the American Board of Family Medicine January 2015, 28 (1) 97-104; DOI: https://doi.org/10.3122/jabfm.2015.01.140258
Ajay Koti
From the Department of Family Medicine, University of South Florida, Morsani College of Medicine, Tampa.
BA
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Richard G. Roetzheim
From the Department of Family Medicine, University of South Florida, Morsani College of Medicine, Tampa.
MD
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  • Article
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Article Figures & Data

Tables

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    Table 1. Documentation of Care Recommended By JNC 7
    CriteriaWeight
    Diagnosis
        1. Cardiovascular risk factors1
        2. Identified blood pressure goal1
        3. BP goal was communicated to the patient, verbally or in writing1
    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 Hg1
        7. Lifestyle modifications discussed during at least 50% of encounters1
    Laboratory monitoring
        8. Fasting lipid panel measured within past 12 months2
        9. Patients with diabetes mellitus and/or chronic kidney disease screened for urine albumin within past 12 months2
        10. Serum creatinine measured within past 12 months2
        11. Blood glucose measured within past 12 months2
        12. Hematocrit measured within past 12 months1
        13. Serum potassium measured within past 12 months1
        14. Serum calcium measured within past 12 months1
        15. EKG measured at any point in the past2
    • BP, blood pressure; EKG, electrocardiogram; HTN, hypertension.

    • View popup
    Table 2. Eligibility Criteria
    InclusionAge 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
    ExclusionEvidence 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.

    • View popup
    Table 3. Documentation Scores for Individual Criteria
    CriteriaDocumentation Score, % (n/N)
    Items evaluated once during the entire audit period
        Cardiovascular risk factors96.7 (145/150)
        Identified BP goal18.7 (28/150)
        BP goal communicated to patient10.7 (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 point78.0 (117/150)
    Items evaluated during multiple visits
        Absence of BP control mentioned in progress note when applicable88.7 (63/71)
        Discussion of lifestyle modification documented for at least 50% of visits in audit period22.0 (33/150)
    • ↵* Measured within the past 12 months.

    • BP, blood pressure; CKD, chronic kidney disease; EKG, electrocardiogram; HTN, hypertension.

    • View popup
    Table 4. Sample Descriptive Statistics and Documentation Scores
    Continuous DataValues*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 white33.3 (50/150)76.9 (14.5)
        Non-Hispanic black33.3 (50/150)77.9 (12.5)
        Hispanic (any race)33.3 (50/150)80.1 (9.7)
    Sex
        Female55.3 (83/150)76.4 (15.0)
        Male44.7 (67/150)80.7 (7.4)
    Marital Status
        Single18.2 (27/148)72.4 (19.5)
        Married62.8 (93/148)80.4 (7.3)
        Divorced/widowed18.9 (28/148)76.4 (15.6)
    Insurance
        Private39.3 (59/150)77.4 (14.9)
        Medicare31.3 (47/150)79.9 (11.2)
        Medicare Advantage21.3 (32/150)79.6 (7.3)
        Medicaid8.0 (12/150)72.8 (13.6)
    • ↵* 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.

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The Journal of the American Board of Family     Medicine: 28 (1)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 1
January-February 2015
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Patient Factors Associated With Documented Provision of JNC 7–Recommended Hypertension Care at an Academic Family Medicine Office
Ajay Koti, Richard G. Roetzheim
The Journal of the American Board of Family Medicine Jan 2015, 28 (1) 97-104; DOI: 10.3122/jabfm.2015.01.140258

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Patient Factors Associated With Documented Provision of JNC 7–Recommended Hypertension Care at an Academic Family Medicine Office
Ajay Koti, Richard G. Roetzheim
The Journal of the American Board of Family Medicine Jan 2015, 28 (1) 97-104; DOI: 10.3122/jabfm.2015.01.140258
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