Hypertension metrics controversial in Core Quality Measures Collaborative



Disagreement over quality measures regarding hypertension has led the American College of Cardiology and the American Heart Association to withhold their imprimatur from the Core Quality Measures Collaborative.

The collaborative ultimately chose to endorse two hypertension measures and will allow physicians to report on either. A measure put forward by the National Quality Forum defines adequate blood pressure control as less than 140/90 mm Hg while a measure from the Healthcare Effectiveness Data and Information Set (HEDIS 2016) defines adequate control as less than 150/90 mm Hg for patients over 60 years of age without diabetes or chronic kidney disease.

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“AHA and ACC have concerns with the inclusion of the HEDIS 2016 measure in these core measure sets because of its likelihood to increase the number of inadequately treated patients with high [blood pressure], who would be at greater risk for heart disease and stroke,” Dr. Richard Chazal, ACC president-elect, and Dr. Mark Creager, AHA president, wrote in an editorial published Feb. 16 in Hypertension (2016 Feb 18. doi: 10.1161/HYP.0000000000000043).

The Core Quality Measures Collaborative is led by the Centers for Medicare & Medicaid Services and America’s Health Insurance Plans, with input from the National Quality Forum, medical societies, employer groups, and consumer groups, with the goal of building a uniform set of quality measures to be used by both public and private payers in value-based payment structures.

The first seven sets of measures under the collaborative were announced Feb. 16; cardiology measures were included in this limited release.

For cardiology, the quality measures span a number of areas, including chronic cardiovascular condition measures (including congestive heart failure, hypertension, ischemic heart disease/coronary heart disease, atrial fibrillation, and prevention) and acute cardiovascular condition measures (including acute myocardial infarction, angioplasty and stents, implantable cardiac defibrillators, cardiac catheterization, and pediatric heart surgery).

A number of measures were identified for future inclusion, including proportion of days covered; defect-free care for acute MI; clinician-level companion measure to hospital risk-standardized complication rate following implantation of implantable cardioverter-defibrillator; postdischarge appointment for heart failure patients; and cardiac stress imaging not meeting appropriate use criteria: routine testing after percutaneous coronary intervention.

Beyond the concerns with the hypertension measure, nothing in particular was left out of the first set of measures, Dr. Paul Casale, a member of the ACC board of trustees, said in an interview. He added that he expects to see more outcomes-related measures in the future.

“There is always the tension between current measures that we can collect more easily, which tend to be some of the more process-related measures, versus the outcomes measures, which everyone would like to see more of,” Dr. Casale said. “But we are challenged, particularly around collection, so I think moving forward we’ll look for opportunities for that.”

The set also identified a few other areas where measures are expected to be developed, including a number around heart failure, renal function measures for hypertension, and others.

According to the editorial in Hypertension, both the ACC and the AHA expect the current hypertension measures to change as new evidence is brought forward.

“AHA and ACC are currently in the process of developing a guideline for [high blood pressure] treatment that will evaluate the full span of evidence, including the endpoint of stroke,” Dr. Chazal and Dr. Creager wrote, noting that the guideline is expected to be released later this year. “Until the new guideline is published, we urge, as we did in an advisory along with the Centers for Disease Control and Prevention in 2014, all health care providers and patients to strive to reach a BP target of less than 140/90 mmHg.”

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