Table 1 Performance of recommended hypertensive care indicators
Indicator | Eligible (n) | Adherence to Indicators (%) | Standard Error (%) |
|---|---|---|---|
1. Systolic and diastolic blood pressure should be measured on patients otherwise presenting for care at least once each year. | 1,953 | 72 | 1.0 |
2. All patients with average blood pressures of Stage 1 or greater as determined on at least 3 separate visits should have a diagnosis of hypertension documented in the record. | 823 | 73 | 1.8 |
3. Patients with a new diagnosis of Stage 1–3 hypertension should have at least 3 or more measurements on separate visits with a mean SBP > 140 or a mean DBP > 90. | 185 | 21 | 3.6 |
4. Medication and substance abuse: Personal history of tobacco abuse, alcohol abuse, or taking of medications that may cause hypertension; | 183 | 35 | 5.0 |
5. Physical examination: examination of the fundi | 199 | 14 | 2.8 |
6. Examination of heart sounds | 199 | 71 | 4.1 |
7. Examination of abdomen for bruits | 199 | 49 | 4.6 |
8. Examination of peripheral arterial pulses | 199 | 32 | 4.1 |
9. Examination of neurologic system | 199 | 35 | 4.6 |
10. Initial laboratory tests should include at least 5 of the following: Urinalysis; | 241 | 30 | 4.3 |
11. Serum, plasma, or blood glucose; | 241 | 65 | 4.2 |
12. Serum potassium; | 241 | 59 | 4.4 |
13. Serum creatinine; | 241 | 62 | 4.2 |
14. Serum cholesterol; or | 241 | 58 | 4.2 |
15. Serum triglyceride. | 241 | 60 | 4.4 |
16. First-line treatment for patients in risk group HN-A or HN-B, is lifestyle modification. The medical record should indicate counseling for at least 1 of the following interventions prior to initiating pharmacotherapy: | 27 | 31 | 10.2 |
- weight reduction if obese; | |||
- increased physical activity if sedentary; or | |||
- low sodium diet. | |||
17. First-line treatment for patients with Stage 1A hypertension, is lifestyle modification. The medical record should indicate counseling for at least 1 of the following interventions prior to initiating pharmacotherapy: | 25 | 25 | 10.4 |
- weight reduction if obese; | |||
- increased physical activity if sedentary; or | |||
- low sodium diet. | |||
18. Treatment for Stage 1B and 1C, and Stages 2 and 3 hypertension should include lifestyle modification. The medical record should indicate counseling for at least 1 of the following interventions: | 149 | 40 | 5.3 |
- weight reduction if obese; | |||
- increased physical activity if sedentary; or | |||
- low sodium diet. | |||
19. Stage 1B hypertensives whose blood pressure remains Stage 1 after 6 months of lifestyle modification recommendation should be offered pharmacotherapy. | 113 | 20 | 4.5 |
20. Stage 1A hypertensives whose blood pressure remains Stage 1 after 12 months of lifestyle modification recommendation should be offered pharmacotherapy. | 22 | 14 | 7.6 |
21. Patients in any risk group with Stage 2–3 hypertension should be offered pharmacotherapy. | 359 | 64 | 3.4 |
22. Patients in Risk group HN-C should be offered pharmacotherapy. | 277 | 67 | 3.9 |
23. Patients in Risk group C with stage 1 hypertension should be offered pharmacotherapy. | 332 | 75 | 2.9 |
24. Hypertensive patients should visit the provider at least once each year. | 1,681 | 94 | 0.7 |
25. Newly diagnosed Stage 1 patients should be evaluated by the provider within 4 months of their initial visit. | 111 | 76 | 5.1 |
26. Newly diagnosed Stage 2 patients should be evaluated by the provider within 2 months of their initial visit. | 56 | 66 | 7.6 |
27. Newly diagnosed Stage 3 patients should be evaluated by the provider within 2 weeks of their initial visit. | 18 | 33 | 12.9 |
28. Hypertensive patients with consistent average SBP > 140 or DBP > 90 over 6 months should have one of the following interventions recorded in the medical record: | 853 | 77 | 1.8 |
- Change in dose or regimen of antihypertensives; or | |||
- Repeated education regarding lifestyle modifications. | |||
Overall | 72 | 1.0 |