Table 8.

New Performance, Quality, and Structural Measures for the Diagnosis and Management of HBP in the Outpatient Care Setting^*

Measure No.	Measure Title	Attribution	Rationale for Creating New Measure
PM-1a	ACC/AHA stage 2 HBP control SBP <140 mm Hg (harmonizing measure)	Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system)	Harmonizes with current performance measure “Controlling High Blood Pressure” for ACC/AHA stage 2 HBP currently in widespread use.
PM-1b	ACC/AHA stage 2 HBP control SBP <130 mm Hg (enhancing measure)	Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system)	Harmonizes with current performance measure “Controlling High Blood Pressure” for ACC/AHA stage 2 HBP currently in widespread use and adds lower target for further risk reduction.
PM-2	ACC/AHA stage 1 HBP control SBP <130 mm Hg (harmonizing measure)	Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system)	Harmonizes with current performance measure “Controlling High Blood Pressure” for ACC/AHA stage 2 HBP currently in widespread use. Adds emphasis on including the ACC/AHA stage 1 HBP population.
PM-3	ACC/AHA stage 2 and stage 1 HBP control SBP <130 mm Hg (composite measure combining PM-1b and PM-2)	Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system)	Harmonizes with current performance measure “Controlling High Blood Pressure” for ACC/AHA stage 2 HBP currently in widespread use. Adds emphasis on including the ACC/AHA stage 1 HBP population and combines both ACC/AHA stage 2 and stage 1 HBP populations.
PM-4	Nonpharmacological interventions for ACC/AHA stage 2 HBP	Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system	Harmonizes with current performance measure “Controlling High Blood Pressure” for ACC/AHA stage 2 HBP currently in widespread use. Adds new emphasis on high-quality evidence and strong recommendation for promoting lifestyle modification, as recommended in the 2017 Hypertension Clinical Practice Guidelines for this population as an important strategy for controlling HBP.
PM-5	Use of HBPM for management of ACC/AHA stage 2 HBP	Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system)	Harmonizes with current performance measure “Controlling High Blood Pressure” for ACC/AHA stage 2 HBP currently in widespread use. Adds new emphasis on correct measurement of BP by individuals at home or elsewhere outside the clinic setting, as recommended in the 2017 Hypertension Clinical Practice Guidelines for this population as an important strategy for evaluating control of HBP.
QM-1	Nonpharmacological interventions for ACC/AHA stage elevated BP	Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system	Adds new emphasis on high-quality evidence and strong recommendation for promoting lifestyle modification, as recommended in the 2017 Hypertension Clinical Practice Guidelines for ACC/AHA elevated BP population as an important strategy for controlling HBP.
QM-2	Nonpharmacological interventions for ACC/AHA stage 1 HBP	Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system	Adds new emphasis high-quality evidence and strong recommendation for promoting lifestyle modification, as recommended in the 2017 Hypertension Clinical Practice Guidelines for ACC/AHA stage 1 population as an important strategy for controlling HBP.
QM-3	Nonpharmacological interventions for all ACC/AHA stages of HBP (composite measure combining PM-4, QM-1, and QM-2)	Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system	Adds new emphasis on high-quality evidence and strong recommendation for promoting lifestyle modification, as recommended in the 2017 Hypertension Clinical Practice Guidelines for all 3 ACC/AHA stages of HBP population as an important strategy for controlling HBP. Composite measure permits assessment of effectiveness for all stages combined.
QM-4	Medication adherence to drug therapy for ACC/AHA stage 1 with ASCVD risk ≥10% or ACC/AHA stage 2 HBP	Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system	Adds new emphasis on high-quality evidence and strong recommendation for assessing and promoting medication adherence, as recommended in the 2017 Hypertension Clinical Practice Guidelines for the combined ACC/AHA stage 1 with ASCVD risk ≥10% and ACC/AHA stage 2 HBP population as an important strategy for controlling HBP.
QM-5	Use of HBPM for management of ACC/AHA stage 1 HBP	Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system	Harmonizes with new performance measure PM-5 for ACC/AHA stage 2 HBP. Adds new emphasis on correct measurement of BP by individuals at home or elsewhere outside the clinic setting, as recommended in the 2017 Hypertension Clinical Practice Guidelines for this population as an important strategy for evaluating control of ACC/AHA stage 1 HBP and ASCVD risk ≥10%.
QM-6	Use of HBPM for management of ACC/AHA stage 1 or ACC/AHA stage 2 (composite measure combining PM-5 and QM-5)	Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system)	Harmonizes with new measures PM-5 and QM-5 and adds new emphasis on correct measurement of BP by individuals at home or elsewhere outside the clinic setting, as recommended in the 2017 Hypertension Clinical Practice Guidelines for this population as an important strategy for evaluating control of ACC/AHA stage 2 and stage 1 HBP and ASCVD risk ≥10%. Composite measure permits assessment of effectiveness for these 2 stages combined.
SM-1	Use of a standard protocol to consistently and correctly measure BP in the ambulatory setting	CDU†	Accurate measurement and recording of BP are essential to categorize level of BP, ascertain BP-related CVD risk, and guide management of high BP Office BP measurement is often unstandardized, despite the well-known consequences of inaccurate measurement. Errors are common and can result in a misleading estimation of an individual’s true level of BP if staff are not trained and a protocol is not followed.
SM-2	Use of a standard process for assessing ASCVD risk	CDU†	To facilitate decisions about preventive interventions, it is recommended to screen for traditional ASCVD risk factors and apply the race- and sex-specific PCE (ASCVD Risk Estimator) to estimate 10-year ASCVD risk for asymptomatic adults 40–79 years of age.
SM-3	Use of a standard process for properly screening all adults ≥18 y of age for HBP	CDU†	The evidence on the benefits of screening for HBP is well established. In 2007, the USPSTF reaffirmed its 2003 recommendation to screen for HBP in adults ≥18 y of age.
SM-4	Use of an EHR to accurately diagnose and assess HBP control	CDU†	A growing number of health systems are developing or using registries and EHRs that permit large-scale queries to support population health management strategies to identify undiagnosed or undertreated HBP.
SM-5	Use of a standard process to engage patients in shared decision-making, tailored to their personal benefits, goals, and values for evidence-based interventions to improve control of HBP	CDU†	Decisions about primary prevention should be collaborative decisions made between a clinician and a patient.
SM-6	Demonstration of infrastructure and personnel that assess and address social determinants of health of patients with HBP	CDU†	It is important to tailor advice to an individual’s socioeconomic and educational status, as well as cultural, work, and home environments.
SM-7	Use of team-based care to better manage HBP	CDU†	RCTs and meta-analyses of RCTs of team-based HBP care involving nurse or pharmacist intervention demonstrated reductions in SBP and DBP and/or greater achievement of BP goals when compared with usual care.
SM-8	Use of telehealth, m-health, e-health, and other digital technologies to better diagnose and manage HBP	CDU†	Meta-analyses of RCTs of different telehealth interventions have demonstrated greater SBP and DBP reductions and a larger proportion of patients achieving BP control than those achieved with usual care without telehealth.
SM-9	Use of a single, standardized plan of care for all patients with HBP	CDU†	Studies demonstrate that implementation of a plan of care for HBP can lead to sustained reduction of BP and attainment of BP targets over several years.
SM-10	Use of performance and quality measures to improve quality of care for patients with HBP	CDU†	A large observational study showed that a systematic approach to HBP control, including the use of performance measures, was associated with significant improvement in HBP control compared with historical control groups.

^*Including office, clinic, home, or ambulatory.

^†Including, but not limited to, solo/small physician offices, group practices, ambulatory care centers, health systems, public health sites, accountable care organizations, and clinically integrated networks that diagnose and treat patients with HBP.

ACC indicates American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CDU, care delivery unit; CVD, cardiovascular disease; DBP, diastolic blood pressure; e-health, healthcare services provided electronically via the Internet; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; m-health, practice of medicine and public health supported by mobile devices; PCE, pooled cohort equations; PM, performance measure; QM, quality measure; RCT, randomized controlled trial; SBP, systolic blood pressure; SM, structural measure; and USPSTF, US Preventive Services Task Force.