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A New Approach for Measuring Quality of Care for Women With Hypertension
Steven M. Asch, MD, MPH;
Eve A. Kerr, MD, MPH;
Pablo Lapuerta, MD;
Anandi Law, PhD;
Elizabeth A. McGlynn, PhD
Arch Intern Med. 2001;161:1329-1335.
Background Guidelines for care of hypertensive patients have proliferated recently,
yet quality assessment remains difficult in the absence of well-defined measurement
systems. Existing systems have not always linked process measures to blood
pressure outcomes.
Methods A quality measurement system was developed and tested on hypertensive
women in a West Coast health plan. An expert panel selected clinically detailed,
evidence-explicit indicators using a modified Delphi method. Thirteen indicators
(1 screening, 5 diagnostic, 5 treatment, and 2 follow-up indicators) were
selected by this process. Trained nurses used a laptop-based tool to abstract
data from medical records for the most recent 2 years of care.
Results Of 15 004 eligible patients with hypertensive and other chronic
disease codes, 613 patients were sampled, all eligible for the screening indicator.
Of these, 234 women with an average blood pressure of 140/90 mm Hg or more,
or a documented diagnosis of hypertension, were studied for the remaining
indicators. The average woman received 64% of the recommended care.
Most patients did not receive adequate initial history, physical examination,
or laboratory tests. Only 37% of hypertensive women with persistent elevations
to more than 160/90 mm Hg had changes in therapy or lifestyle recommended.
The average adherence proportion to all indicators was lower in patients with
uncontrolled blood pressure (>140/90 mm Hg) than in those with controlled
blood pressure (54% vs 73%; P<.001).
Conclusions Quality of hypertensive care falls short of indicators based on randomized
controlled trials and national guidelines. Poor performance in essential care
processes is associated with poor blood pressure control.
From the Veterans Affairs Greater Los Angeles Health Care System, Los
Angeles, Calif (Dr Asch); Department of Medicine, University of California,
Los Angeles (Dr Asch); Center for Research on Quality in Health Care, RAND,
Santa Monica, Calif (Drs Asch, Kerr, Law, and McGlynn); Bristol-Myers Squibb
Pharmaceutical Research Institute, Princeton, NJ (Dr Lapuerta); Veterans Affairs
Center for Practice Management and Outcomes Research, Veterans Affairs Ann
Arbor Health Care System, Ann Arbor, Mich (Dr Kerr); Department of Medicine,
University of Michigan, Ann Arbor (Dr Kerr); and Western University of Health
Sciences, Pomona, Calif (Dr Law). Dr Asch is a consultant for Bristol-Myers
Squibb.
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