title: Quality of care for hypertension in the United States.
abstract: BACKGROUND
  Despite heavy recent emphasis on blood pressure (BP) control, many patients fail to meet widely accepted goals. While access and adherence to therapy certainly play a role, another potential explanation is poor quality of essential care processes (QC). Yet little is known about the relationship between QC and BP control.
  
  
  METHODS
  We assessed QC in 12 U.S. communities by reviewing the medical records of a randomly selected group of patients for the two years preceding our study. We included patients with either a diagnosis of hypertension or two visits with BPs of >or=140/90 in their medical records. We used 28 process indicators based on explicit evidence to assess QC. The indicators covered a broad spectrum of care and were developed through a modified Delphi method. We considered patients who received all indicated care to have optimal QC. We defined control of hypertension as BP < 140/90 in the most recent reading.
  
  
  RESULTS
  Of 1,953 hypertensive patients, only 57% received optimal care and 42% had controlled hypertension. Patients who had received optimal care were more likely to have their BP under control at the end of the study (45% vs. 35%, p = .0006). Patients were more likely to receive optimal care if they were over age 50 (76% vs. 63%, p < .0001), had diabetes (77% vs. 71%, p = .0038), coronary artery disease (87% vs. 69%, p < .0001), or hyperlipidemia (80% vs. 68%, p < .0001), and did not smoke (73% vs. 66%, p = .0005).
  
  
  CONCLUSIONS
  Higher QC for hypertensive patients is associated with better BP control. Younger patients without cardiac risk factors are at greatest risk for poor care. Quality measurement systems like the one presented in this study can guide future quality improvement efforts.
authors.affiliation: West LA VA, Mail Code 111G, 11301 Wilshire Bl, Los Angeles, CA 90073, USA. sasch@rand.org
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGlynn
authors.forename: Liisa
authors.initials: L
authors.lastname: Hiatt
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hicks
authors.forename: Alison
authors.initials: A
authors.lastname: DeCristofaro
authors.forename: Roland
authors.initials: R
authors.lastname: Chen
authors.forename: Pablo
authors.initials: P
authors.lastname: LaPuerta
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents