Diabetes: Blood Pressure Management (NQF 0061)

eMeasure Name Diabetes: Blood Pressure Management eMeasure Id 8ce0bd83-8e22-47ba-8d1d-cf447e189739
Version number 1 eMeasure Set Id 120ff978-f491-4002-aeeb-d8608f74fde8
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had BP < 140/90 mmHg.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who sustain adequate blood pressure control. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life-threatening, life-ending or life-altering complications, including poor blood pressure control and subsequent cardiovascular disease of varying severity. Maintaining a healthy blood pressure has been shown to reduce complications due to diabetes, with a 10 mm Hg reduction in systolic blood pressure lowering the risk of complications by 12%. It also reduces the chance of cardiovascular disease among patient with diabetes by up to 50% and reduces the chance of other related complications (eye, kidney, nerve) by more than 25%. This measure facilitates long-term management of blood pressure levels for patients diagnosed with diabetes.
Clinical Recommendation Statement
Statement American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE): Recommends that a blood pressure determination during the initial evaluation, including orthostatic evaluation, be included in the initial and every interim physical examination.
                
American College of Physicians (ACP): Blood pressure control must be a priority in the management of persons with hypertension and type 2 diabetes.

American Diabetes Association (ADA): Blood pressure should be measured at every routine diabetes visit. Patients found to have systolic blood pressure >130 mmHg or diastolic >80 mmHg should have blood pressure confirmed on a separate day. Orthostatic measurement of blood pressure should be performed to assess for the presence of autonomic neuropathy. (Level of Evidence: E)

American Geriatrics Society (AGS): Older persons with diabetes are likely to benefit greatly from cardiovascular risk reduction, therefore monitor and treat hypertension and dyslipidemias.

JNC VII: Recommends that measurement of blood pressure in the standing position is indicated periodically, especially in those at risk for postural hypotension. At least two measurements should be made and the average recorded. After BP is at goal and stable, follow-up visits can usually be at 3-to 6- month intervals. Co-morbidities such as heart failure, associated diseases such as diabetes, and the need for laboratory tests influence the frequency of visits.

National Kidney Foundation (NKF): Recommends that all individuals should be evaluated during health encounters to determine whether they are at increased risk of having or of developing chronic kidney disease. This evaluation of risk factors should include blood pressure measurement.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
American Association of Clinical Endocrinologists and American College of Endocrinology. The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self-Management-2002
Reference
California Healthcare Foundation/American Geriatrics Society (AGS) Improving Care of Elders with Diabetes. Guidelines for Improving the Care of the Older Person with Diabetes Mellitus. J Am Geriatr Soc 2003;51:S265-S280. Available at http://ww.americangeriatrics.org/education/diabetes_executive_summary.shtml Accessed September 2004.
Reference
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). NIH Publication No. 04-5230, August 2004.
Definition
Initial Patient Population(s): All patients 18 to 75 years of age during the measurement period
Definition
Denominator(s): Patients in the initial population with a diagnosis of diabetes and at least 2 non-acute inpatient or outpatient encounters, or currently receiving medications indicative of diabetes during the measurement period or in the 12 months prior to the measurement period
Definition
Denominator Exclusion(s): Patients with a diagnosis of polycystic ovaries, gestational diabetes or steroid-induced diabetes who did not have any face-to-face encounters in any setting, with a diagnosis of diabetes, during the measurement period or the 12 months prior to the measurement period
Definition
Numerator(s): The number of patients whose most recent BP reading during the measurement period was <140/90 mm Hg
Definition
Denominator Exception(s): N/A
Guidance
Numerator element: 
Only blood pressure readings performed by a clinician in the provider office is acceptable for numerator compliance with this measure.  Blood pressure readings from the patient's home (including readings directly from monitoring devices) are not acceptable.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012