Meeting the metric: Do your hypertensive patients have a well-controlled blood pressure?
You shouldn't be talking to the patient while measuring blood pressure.
The best way to check blood pressure
Blood pressure control is an important area of focus in value-based care. As providers, we must make sure we are appropriately treating high blood pressure.
It is also important to ensure measurements are obtained correctly to help us document accurate blood pressure. In turn, we improve patient care and quality metrics.
When checking blood pressure, the patient should be sitting still and quiet. This provides a more relaxed atmosphere. You shouldn’t be talking to the patient while measuring blood pressure.
Many times, we measure blood pressure immediately after walking the patient down the hall and into the exam room. A more accurate blood pressure measurement will be obtained by waiting until the end of the rooming process to check it. If the blood pressure is elevated, it should be rechecked after a few minutes of rest.
Ideally, the patient should not smoke, drink caffeine or exercise for 30 minutes prior to checking the blood pressure. It also helps for the patient to have an empty bladder, as a full bladder can cause a falsely elevated blood pressure reading.
It is important to sit correctly. The patient’s feet should be flat on the floor, not hanging down from the exam table. The arm should be supported on a flat surface, with the upper arm at heart level.
Do not take a blood pressure measurement over the patient’s clothes. The blood pressure cuff should be touching bare skin.
Meeting the metric for blood pressure
As part of our value-based care agreements, controlling high blood pressure is one of the quality metrics. The quality measure is based on the “percentage of patients 18-85 years of age who had a diagnosis of hypertension, and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period.”
It is important to note that a blood pressure of 140/90 does not meet the metric. The recorded blood pressure must be 139/89 or below to be considered controlled.
Only the last blood pressure recorded in the chart during the measurement period counts for the quality metric. If you see a patient in your office with a controlled blood pressure, and that patient is later seen elsewhere (ER, urgent care, specialist's office or anywhere else a blood pressure is measured and recorded) and a blood pressure of 140/90 or higher is recorded, that patient no longer meets the quality metric.
If you notice a patient has been seen elsewhere with a high blood pressure reading, you should follow up with that patient to recheck the blood pressure prior to the end of the measurement period, which is currently based on a calendar year (Dec. 31).
By working together and providing excellent care to our patients, we can greatly improve our quality scores for “Hypertension: Controlling High BP.”
Brian Chaney, MD, CPE, FAAFP, is medical director of Quality for Baptist Health Medical Group. A practicing physician, he is using this column to explain Baptist Health’s population health strategies and quality measures.