Standard-Based Method is Preferred Measure of Treatment Intensity for BP Control
One possible measure of the quality of hypertension care is the intensity of clinical management when blood pressure (BP) is uncontrolled, thus there is increasing interest in measuring treatment intensification (TI). This study compared different TI measures in predicting BP control among 819 outpatients with hypertension who were treated at one academic non-VA hospital in Boston between 8/04 and 6/06. The three TI scores/measures evaluated were: 1) any/none score, which divides patients into those who had any therapy increase during the study vs. none; 2) Norm-Based Method (NBM), which scores each patient based on whether they received more or fewer medication increases than predicted at each visit; and 3) Standard-Based Method (SBM), which is similar to NBM but expects a medication increase whenever the BP is uncontrolled. Electronic medical record data were used to assess patients' BP control and treatment changes.
Findings show that the SBM score was an excellent predictor of the final systolic blood pressure, thus the authors suggest that SBM serve as the basis for research and quality improvement efforts for better hypertension care. The any/none measure produced paradoxical results (therapy increases were associated with a higher final BP), while the NBM was not predictive of BP control.
Rose A, Berlowitz D, Manze M, et al. Comparing methods of measuring treatment intensification in hypertension care. Circulation: Cardiovascular Quality and Outcomes July 2009;2(4):385-91.
Dr. Rose is supported by an HSR&D Career Development Award. Drs. Rose and Berlowitz are part of HSR&D's Center for Health Quality, Outcomes, and Economic Research in Bedford, MA.