Measure Components	The CDU uses performance and quality measures for evaluation and improvement in clinical settings for the diagnosis and management of patients with HBP, which include:
	• Performance measures that are developed according to established ACC/AHA standards.
	• Performance measures that identify key structural components, care processes, and/or outcomes that are highly correlatec with important, high-priority patient care goals.
	• Methods to accurately and feasibly collect data in order to assess performance measures.
	• Process to identify appropriate patient groups, healthcare providers, and/or observation periods to be included in the measurement process.
	• Process to include outcomes of performance measurement in quality improvement strategies.
Rationale
Performance measures are systematic and standardized methods that are aimed at identifying and improving suboptimal medical care and patient outcomes Performance measures represent one of several potential strategies that can be used, together or alone, to help reduce gaps in the quality of health care. Effective performance measures are those that are associated with meaningful, desirable patient outcomes and include broad sampling from appropriate and related medical domains.2 Performance measure design should follow established standards, as outlined by national organizations,2 and have precise, validated components that are feasible, actionable, and meaningful. Performance measures usually reflect clinical practice guidelines of the highest levels of recommendation and evidence. Given that the identification, treatment, and control of HBP are suboptimal,3,225,226 use of effective performance measures ca help improve these gaps in care, as has been shown in 1 observational study from Kaiser Permanente of Northern California.56 No RCTs of HBP performance measures have been published.4
Implementation of Performance Measures
1. Identify performances measures for hypertension that:
a. Meet established ACC/AHA standards.
b. Include key components that influence the impact and sustainability of hypertension detection, treatment, and control for the target population (medical care, cost of care, patient-reported factors).
c. Help address the most pressing gaps in hypertension-related care for the healthcare provider, practice, or system.
2. Coordinate the most feasible and meaningful collection of performance measures data with available data sources (eg, electronic health records, national data registries, administrative databases).
Uses of Performance Measures
1. To assess performance of the healthcare provider, practice, or system, identifying and characterizing gaps in quality of hypertension care (based on comparison to a national “benchmark” standard or based on comparison to previous performance by the same healthcare provider, practice, or system).
2. To be used to design and implement quality improvement plans to help address gaps in quality of hypertension care identified by performance measures.
3. To report the use and outcomes of performance measurement as part of healthcare quality payment programs that are used by organizations to determine reimbursement to healthcare providers, practices, and systems on the basis of achievement and reporting of various performance metrics.
Clinical Recommendations
2017 Hypertension Clinical Practice Guidelines4
Recommendation for Performance Measures (Guideline Section 12.4.1)
1. Use of performance measures in combination with other quality improvement strategies at patient-, provider-, and system-based levels is reasonable to facilitate optimal hypertension control.56,227,228 (Class 2a, Level of Evidence: B-NR)

ACC indicates American College of Cardiology; AHA, American Heart Association; CDU, care delivery unit; HBP, high blood pressure; and RCT, randomized controlled trial.