Often called “the silent killer,” hypertension (high blood pressure) can lead to serious health issues such as heart disease and stroke. Controlling hypertension is a critical element of preventing and managing these chronic diseases. That’s why Partners HealthCare has implemented a number of initiatives targeting the diagnosis and treatment of hypertension as part of our commitment to delivering high quality care.
What is our approach to managing quality for such large populations of patients?
Partners eCare, our electronic health record, allows us to collect health information and develop standardized lists, known as “registries”, to track lab results, blood pressure readings, and other relevant clinical information – all in a single location for an entire population of patients. Our population health coordinators work with our clinical team to review the data from these patient registries regularly, so they can reach out to patients who would benefit from updated lab testing, blood pressure monitoring, procedures, or medication therapy.
What are we measuring and why?
Controlling hypertension can prevent the serious health complications and is considered a core element of chronic disease prevention and care.
How does this measure differ from traditional metrics that rely on claims (billing) data?
We use our electronic health record (EHR) data to identify patients with hypertension, using information entered by clinicians into the general patient problem list and billing diagnoses. This approach more accurately identifies patients with this condition by accounting for risks like age (where risk/benefit assessments of aggressive blood pressure control are needed), presence of diabetes (where more aggressive blood control may be needed), and whether someone is already at maximum medication therapy, enabling clinicians to make better clinical decisions about patient care.
Blood Pressure Control
We track the percentage of eligible patients diagnosed with hypertension whose most recent blood pressure reading (within the past 6 months) demonstrates their hypertension is well controlled.
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Read more details about this measure.
| Total Eligible Patients |
|---|
| Year |
BWPO |
CRMA |
MGPO |
NWPHO |
NSHS |
PHS |
| 2017 |
42,754 |
Not Available* |
54,429 |
27,242 |
Not Available* |
124,425 |
| 2018 |
43,124 |
18,911 |
57,939 |
27,204 |
31,412 |
178,590 |
*2017 data for North Shore Health System and Charles River Medical Associates could not be collected until they upgraded to Partners’ new electronic medical record and had 1 full year of data.
Measure Details
Data Periods: October 2016 - September 2017 and October 2017 - September 2018
Partners HealthCare Data Source: Electronic Health Record (EHR) System
Numerator: The number of patients with a recorded blood pressure reading in the most recent six months AND either 1) the most recent blood pressure reading meets the blood pressure goal, OR 2) the average of the most recent 3 blood pressure readings within the last 18 months meets the blood pressure goals as defined below:
- Age < 60 years, blood pressure ≤ 140/90 mmHg
- Age ≥ 60 years
- Without a diagnosis of diabetes, blood pressure ≤ 150/90 mmHg
- With a diagnosis of diabetes, blood pressure ≤ 140/90 mmHg
- Diastolic blood pressure < 70 mmHg
- Prescribed three or more antihypertensive medications from three different drug classes (regardless of blood pressure readings)
Denominator: Adult patients (age ≥ 18 years) with hypertension defined as 1) a diagnosis present on the electronic problem list, or 2) a clinician-entered diagnosis during an office visit in the most recent 12 months, or 3) presence of a billing diagnosis (claims data) in the last 12 months.
Measure Details
Permanent exclusions allow our clinicians to identify patients for whom we are not actively managing hypertension. We remove these patients from the denominator. This includes patients who are deceased, no longer receiving care from our primary care physician, or those incorrectly diagnosed with hypertension.
Permanent exceptions allow our clinicians to identify patients correctly diagnosed with hypertension, but for whom aggressive blood pressure control is no longer clinically appropriate. We count these patients as contributing positively to the numerator. This includes patients with a terminal illness or advanced dementia.
Temporary exceptions allow our clinicians to identify patients correctly diagnosed with hypertension, but for whom aggressive blood pressure control may be temporarily not clinically appropriate. We count these patients as contributing positively to the numerator for 12 months following this designation. This includes patients who have a competing comorbidity, are compliant with maximum tolerated therapy, are intolerant to medical therapy or have a contraindication, are declining medication, or are not able to afford medication.
