Document Detail

Monitoring performance for blood pressure management among patients with diabetes mellitus: too much of a good thing?
MedLine Citation:
PMID:  22641246     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Performance measures that reward achieving blood pressure (BP) thresholds may contribute to overtreatment. We developed a tightly linked clinical action measure designed to encourage appropriate medical management and a marker of potential overtreatment, designed to monitor overly aggressive treatment of hypertension in the face of low diastolic BP.
METHODS: We conducted a retrospective cohort study in 879 Department of Veterans Affairs (VA) medical centers and smaller community-based outpatient clinics. The clinical action measure for hypertension was met if the patient had a passing index BP at the visit or had an appropriate action. We examined the rate of passing the action measure and of potential overtreatment in the Veterans Health Administration during 2009-2010.
RESULTS: There were 977,282 established VA patients, 18 years and older, with diabetes mellitus (DM). A total of 713,790 patients were eligible for the action measure; 94% passed the measure (82% because they had a BP <140/90 mm Hg at the visit and an additional 12% with a BP ≥140/90 mm Hg and appropriate clinical actions). Facility pass rates varied from 77% to 99% (P < .001). Among all patients with DM, 197,291 (20%) had a BP lower than 130/65 mm Hg; of these, 80 903 (8% of all patients with DM) had potential overtreatment. Facility rates of potential overtreatment varied from 3% to 20% (P < .001). Facilities with higher rates of meeting the current threshold measure (<140/90 mm Hg) had higher rates of potential overtreatment (P < .001).
CONCLUSIONS: While 94% of diabetic veterans met the action measure, rates of potential overtreatment are currently approaching the rate of undertreatment, and high rates of achieving current threshold measures are directly associated with overtreatment. Implementing a clinical action measure for hypertension management, as the Veterans Health Administration is planning to do, may result in more appropriate care and less overtreatment.
Eve A Kerr; Michelle A Lucatorto; Rob Holleman; Mary M Hogan; Mandi L Klamerus; Timothy P Hofer;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  172     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-08-22     Completed Date:  2012-09-25     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  938-45     Citation Subset:  AIM; IM    
Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48113-0170, USA.
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MeSH Terms
Antihypertensive Agents / therapeutic use
Blood Pressure
Cohort Studies
Diabetes Mellitus / epidemiology*
Hospitals, Veterans
Hypertension / drug therapy*,  epidemiology*
Middle Aged
Physician Incentive Plans
Quality Indicators, Health Care*
Reimbursement, Incentive
Retrospective Studies
United States
Young Adult
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents
Eve Kerr / ; Michelle Lucatorto / ; David Aron / ; William Cushman / ; John R Downs / ; Leonard Pogach / ; Sandeep Vijan /
Comment In:
Arch Intern Med. 2012 Jun 25;172(12):945-6   [PMID:  22641271 ]
Arch Intern Med. 2012 Dec 10;172(22):1769; author reply 1770   [PMID:  23229941 ]

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