Title: Controlling High Blood PressureFHIR Id: ControllingHighBloodPressureFHIR Download cql: ControllingHighBloodPressureFHIR.cql Version: 0.0.001 Url: Controlling High Blood PressureFHIR short-name identifier: CMS165FHIR version-independent identifier: urn:uuid:9017d914-6748-45a9-bff1-8392ed644a7b version-specific identifier: urn:uuid:e254a6be-bec3-4304-87bc-d85ad3d8fa39 publisher (CMS) identifier: 165FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-09-07 19:36:39+0000 Approval Date: 2023-08-28 Last Review Date: 2023-08-28 Name: ControllingHighBloodPressureFHIR Publisher: National Committee for Quality Assurance Author: National Committee for Quality Assurance: https://www.ncqa.org/ Description: Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period Use Context: code value program Purpose: UNKNOWN Copyright: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved. Disclaimer: The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. Rationale: High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2021). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults >= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022). HBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the US; a person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of >= 160 mmHg could be effective and cost-saving (Moran, 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mmHg compared to a SBP goal of <140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established. Clinical recommendation statement: U.S. Preventive Services Task Force (USPSTF) (2021): The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017): For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)). American College of Physicians and the American Academy of Family Physicians (2017): Initiate or intensify pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, Quality of evidence: low) Initiate or intensify pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, Quality of evidence: moderate) American Diabetes Association (2021): For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15 percent), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: C) For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15 percent), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A) Guidance (Usage): In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record. Do not include BP readings taken during an acute inpatient stay or an ED visit. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled". If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS165v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html). Population Criteria: 643716e4d4d7050edabb0444 Initial Population: Patients 18-85 years of age by the end of the measurement period who had a visit during the meaurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period Denominator: Equals Initial Population Denominator Exclusion: Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. Denominator Exception: None Numerator: Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period Numerator Exclusion: None Supplemental Data Guidance : Supplemental Data Elements: SDE Ethnicity SDE Payer SDE Race SDE Sex Libraries: ControllingHighBloodPressureFHIR Related Artifact Dependencies: SupplementalDataElements version: 3.4.000 Status version: 1.6.000 FHIRHelpers version: 4.3.000 QICoreCommon version: 1.5.000 AdultOutpatientEncounters version: 4.6.000 Hospice version: 6.7.000 AdvancedIllnessandFrailty version: 1.6.000 CQMCommon version: 1.4.000 CumulativeMedicationDuration version: 3.3.000 PalliativeCare version: 1.7.000 LOINC SNOMED CT (all versions) Observation Category Codes Essential Hypertension Office Visit Annual Wellness Visit Preventive Care Services - Established Office Visit, 18 and Up Preventive Care Services-Initial Office Visit, 18 and Up Home Healthcare Services Virtual Encounter Telephone Visits Payer Encounter Inpatient Hospice Encounter Hospice Care Ambulatory Hospice Diagnosis Pregnancy End Stage Renal Disease Kidney Transplant Recipient Chronic Kidney Disease, Stage 5 Kidney Transplant Dialysis Services ESRD Monthly Outpatient Services Frailty Device Frailty Diagnosis Frailty Encounter Frailty Symptom Outpatient Observation Emergency Department Visit Nonacute Inpatient Advanced Illness Acute Inpatient Dementia Medications Palliative Care Diagnosis Palliative Care Encounter Palliative Care Intervention Parameters: name use min max type Measurement Period In 0 1 Period ErrorLevel In 0 1 string SDE Sex Out 0 1 Coding Numerator Out 0 1 boolean Denominator Out 0 1 boolean SDE Payer Out 0 * Resource Initial Population Out 0 1 boolean SDE Ethnicity Out 0 1 Resource Denominator Exclusions Out 0 1 boolean SDE Race Out 0 1 Resource DataRequirements: Type Elements Valueset Name Valueset Patient(QICorePatient) Patient(QICorePatient) url extension Patient(QICorePatient) url extension Encounter(QICoreEncounter) id id.value Encounter(QICoreEncounter) type hospitalization hospitalization.dischargeDisposition period Encounter Inpatient Encounter Inpatient Encounter(QICoreEncounter) type period Hospice Encounter Hospice Encounter Encounter(QICoreEncounter) type period ESRD Monthly Outpatient Services ESRD Monthly Outpatient Services Encounter(QICoreEncounter) type period Frailty Encounter Frailty Encounter Encounter(QICoreEncounter) type period Acute Inpatient Acute Inpatient Encounter(QICoreEncounter) type period Palliative Care Encounter Palliative Care Encounter Observation(Observation Blood Pressure Profile) encounter encounter.class encounter.class.code effective component Condition(QICoreCondition) code Essential Hypertension Essential Hypertension Condition(QICoreCondition) code Hospice Diagnosis Hospice Diagnosis Condition(QICoreCondition) code Frailty Diagnosis Frailty Diagnosis Condition(QICoreCondition) id id.value Condition(QICoreCondition) code Palliative Care Diagnosis Palliative Care Diagnosis Coverage(QICoreCoverage) type period Payer Type Payer Observation(QICoreObservation) code value effective Observation(QICoreObservation) code value effective Observation(QICoreObservation) code effective Frailty Symptom Frailty Symptom Observation(QICoreObservation) code effective value Observation(QICoreObservation) code effective value Observation(QICoreObservation) code effective ServiceRequest(QICoreServiceRequest) code authoredOn authoredOn.value Hospice Care Ambulatory Hospice Care Ambulatory Procedure(QICoreProcedure) code performed Hospice Care Ambulatory Hospice Care Ambulatory Procedure(QICoreProcedure) code performed Palliative Care Intervention Palliative Care Intervention Direct Reference Codes: display code system Systolic blood pressure 8480-6 http://loinc.org Diastolic blood pressure 8462-4 http://loinc.org Discharge to home for hospice care (procedure) 428361000124107 http://snomed.info/sct Discharge to healthcare facility for hospice care (procedure) 428371000124100 http://snomed.info/sct survey survey http://terminology.hl7.org/CodeSystem/observation-category Hospice care [Minimum Data Set] 45755-6 http://loinc.org Yes (qualifier value) 373066001 http://snomed.info/sct Medical equipment used 98181-1 http://loinc.org Housing status 71802-3 http://loinc.org Lives in a nursing home (finding) 160734000 http://snomed.info/sct Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) 71007-9 http://loinc.org Logic Definitions: Group Scoring Population Criteria Expression 643716e4d4d7050edabb0444 Group scoring: proportion Initial Population define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters" Denominator define "Denominator": "Initial Population" Denominator Exclusion define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period" Denominator Exception None Numerator define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90" Numerator Exclusion None Library Name Name SupplementalDataElements SDE Sex define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end Library Name Name ControllingHighBloodPressureFHIR SDE Sex define "SDE Sex": SDE."SDE Sex" Library Name Name ControllingHighBloodPressureFHIR Qualifying Systolic Blood Pressure Reading define "Qualifying Systolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period" Library Name Name ControllingHighBloodPressureFHIR Qualifying Diastolic Blood Pressure Reading define "Qualifying Diastolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period" Library Name Name ControllingHighBloodPressureFHIR Blood Pressure Days define "Blood Pressure Days": ( "Qualifying Diastolic Blood Pressure Reading" DBPExam return date from DBPExam.effective.latest ( ) ) intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam return date from SBPExam.effective.latest ( ) ) Library Name Name ControllingHighBloodPressureFHIR Most Recent Blood Pressure Day define "Most Recent Blood Pressure Day": Last("Blood Pressure Days" BPDays sort asc ) Library Name Name ControllingHighBloodPressureFHIR Lowest Systolic Reading on Most Recent Blood Pressure Day define "Lowest Systolic Reading on Most Recent Blood Pressure Day": First("Qualifying Systolic Blood Pressure Reading" SBPReading where SBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(SBPReading.component SBPComponent where SBPComponent.code ~ "Systolic blood pressure" return SBPComponent.value as Quantity ) sort asc ) Library Name Name ControllingHighBloodPressureFHIR Has Systolic Blood Pressure Less Than 140 define "Has Systolic Blood Pressure Less Than 140": "Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]' Library Name Name ControllingHighBloodPressureFHIR Lowest Diastolic Reading on Most Recent Blood Pressure Day define "Lowest Diastolic Reading on Most Recent Blood Pressure Day": First("Qualifying Diastolic Blood Pressure Reading" DBPReading where DBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(DBPReading.component DBPComponent where DBPComponent.code ~ "Diastolic blood pressure" return DBPComponent.value as Quantity ) sort asc ) Library Name Name ControllingHighBloodPressureFHIR Has Diastolic Blood Pressure Less Than 90 define "Has Diastolic Blood Pressure Less Than 90": "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]' Library Name Name ControllingHighBloodPressureFHIR Numerator define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90" Library Name Name ControllingHighBloodPressureFHIR Essential Hypertension Diagnosis define "Essential Hypertension Diagnosis": ( [Condition: "Essential Hypertension"] ) Hypertension where Hypertension.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months ) Library Name Name AdultOutpatientEncounters Qualifying Encounters define "Qualifying Encounters": ( ( [Encounter: "Office Visit"] union [Encounter: "Annual Wellness Visit"] union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"] union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"] union [Encounter: "Home Healthcare Services"] union [Encounter: "Online Assessments"] union [Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter where ValidEncounter.period.toInterval() during day of "Measurement Period" Library Name Name ControllingHighBloodPressureFHIR Initial Population define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters" Library Name Name ControllingHighBloodPressureFHIR Denominator define "Denominator": "Initial Population" Library Name Name SupplementalDataElements SDE Payer define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Library Name Name ControllingHighBloodPressureFHIR SDE Payer define "SDE Payer": SDE."SDE Payer" Library Name Name SupplementalDataElements SDE Ethnicity define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Library Name Name ControllingHighBloodPressureFHIR SDE Ethnicity define "SDE Ethnicity": SDE."SDE Ethnicity" Library Name Name Hospice Has Hospice Services define "Has Hospice Services": exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and InpatientEncounter.period.toInterval() ends during day of "Measurement Period" ) or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment where HospiceAssessment.value ~ "Yes (qualifier value)" and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period" ) or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) Library Name Name ControllingHighBloodPressureFHIR Pregnancy or Renal Diagnosis define "Pregnancy or Renal Diagnosis": ( [Condition: "Pregnancy"] union [Condition: "End Stage Renal Disease"] union [Condition: "Kidney Transplant Recipient"] union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period" Library Name Name ControllingHighBloodPressureFHIR End Stage Renal Disease Procedures define "End Stage Renal Disease Procedures": ( ( [Procedure: "Kidney Transplant"] union [Procedure: "Dialysis Services"] ).isProcedurePerformed ( ) ) ESRDProcedure where ESRDProcedure.performed.toInterval ( ) ends on or before end of "Measurement Period" Library Name Name ControllingHighBloodPressureFHIR End Stage Renal Disease Encounter define "End Stage Renal Disease Encounter": ( ( [Encounter: "ESRD Monthly Outpatient Services"] ).isEncounterPerformed ( ) ) ESRDEncounter where ESRDEncounter.period.toInterval ( ) starts on or before end of "Measurement Period" Library Name Name AdvancedIllnessandFrailty Has Criteria Indicating Frailty define "Has Criteria Indicating Frailty": exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrder()) FrailtyDeviceOrder where FrailtyDeviceOrder.doNotPerform() is not true and FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ( (([Observation: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed where EquipmentUsed.value as Concept in "Frailty Device" and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period" ) or exists ( ([Condition: "Frailty Diagnosis"]) FrailtyDiagnosis where FrailtyDiagnosis.prevalenceInterval() overlaps "Measurement Period" ) or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter where FrailtyEncounter.period.toInterval() overlaps "Measurement Period" ) or exists ( (([Observation: "Frailty Symptom"]).isSymptom()) FrailtySymptom where FrailtySymptom.effective.toInterval() overlaps "Measurement Period" ) Library Name Name AdvancedIllnessandFrailty Outpatient Encounters with Advanced Illness define "Outpatient Encounters with Advanced Illness": (( [Encounter: "Outpatient"] union [Encounter: "Observation"] union [Encounter: "Emergency Department Evaluation and Management Visit"] union [Encounter: "Nonacute Inpatient"] ).isEncounterPerformed()) OutpatientEncounter where exists ((OutpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness") and OutpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] Library Name Name AdvancedIllnessandFrailty Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service define "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service": exists ( from "Outpatient Encounters with Advanced Illness" OutpatientEncounter1, "Outpatient Encounters with Advanced Illness" OutpatientEncounter2 where OutpatientEncounter2.period ends 1 day or more after day of end of OutpatientEncounter1.period return OutpatientEncounter1 ) Library Name Name AdvancedIllnessandFrailty Has Inpatient Encounter with Advanced Illness define "Has Inpatient Encounter with Advanced Illness": exists ( ( ([Encounter: "Acute Inpatient"]).isEncounterPerformed()) InpatientEncounter where exists ((InpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness") and InpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] ) Library Name Name AdvancedIllnessandFrailty Has Dementia Medications in Year Before or During Measurement Period define "Has Dementia Medications in Year Before or During Measurement Period": exists (( ([MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication where DementiaMedication.doNotPerform is not true and CMD."MedicationRequestPeriod" ( DementiaMedication ) overlaps Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] ) Library Name Name AdvancedIllnessandFrailty Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty": ( AgeInYearsAt(date from end of "Measurement Period")in Interval[66, 80] and "Has Criteria Indicating Frailty" and ( "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service" or "Has Inpatient Encounter with Advanced Illness" or "Has Dementia Medications in Year Before or During Measurement Period" ) ) or ( AgeInYearsAt(date from end of "Measurement Period")>= 81 and "Has Criteria Indicating Frailty" ) Library Name Name AdvancedIllnessandFrailty Is Age 66 or Older Living Long Term in a Nursing Home define "Is Age 66 or Older Living Long Term in a Nursing Home": AgeInYearsAt(date from end of "Measurement Period" )>= 66 and ( ( Last( (([Observation: "Housing status"]).isAssessmentPerformed()) HousingStatus where HousingStatus.effective.toInterval() ends on or before end of "Measurement Period" sort by end of effective.toInterval() asc )) LastHousingStatus where LastHousingStatus.value ~ "Lives in a nursing home (finding)" ) is not null Library Name Name PalliativeCare Has Palliative Care in the Measurement Period define "Has Palliative Care in the Measurement Period": exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period" ) Library Name Name ControllingHighBloodPressureFHIR Denominator Exclusions define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period" Library Name Name SupplementalDataElements SDE Race define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Library Name Name ControllingHighBloodPressureFHIR SDE Race define "SDE Race": SDE."SDE Race"
Discharge to home for hospice care (procedure)
Discharge to healthcare facility for hospice care (procedure)
Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)
define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
Qualifying Systolic Blood Pressure Reading
define "Qualifying Systolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period"
Qualifying Diastolic Blood Pressure Reading
define "Qualifying Diastolic Blood Pressure Reading": ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period"
define "Blood Pressure Days": ( "Qualifying Diastolic Blood Pressure Reading" DBPExam return date from DBPExam.effective.latest ( ) ) intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam return date from SBPExam.effective.latest ( ) )
define "Most Recent Blood Pressure Day": Last("Blood Pressure Days" BPDays sort asc )
Lowest Systolic Reading on Most Recent Blood Pressure Day
define "Lowest Systolic Reading on Most Recent Blood Pressure Day": First("Qualifying Systolic Blood Pressure Reading" SBPReading where SBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(SBPReading.component SBPComponent where SBPComponent.code ~ "Systolic blood pressure" return SBPComponent.value as Quantity ) sort asc )
Has Systolic Blood Pressure Less Than 140
define "Has Systolic Blood Pressure Less Than 140": "Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]'
Lowest Diastolic Reading on Most Recent Blood Pressure Day
define "Lowest Diastolic Reading on Most Recent Blood Pressure Day": First("Qualifying Diastolic Blood Pressure Reading" DBPReading where DBPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(DBPReading.component DBPComponent where DBPComponent.code ~ "Diastolic blood pressure" return DBPComponent.value as Quantity ) sort asc )
Has Diastolic Blood Pressure Less Than 90
define "Has Diastolic Blood Pressure Less Than 90": "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]'
define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90"
define "Essential Hypertension Diagnosis": ( [Condition: "Essential Hypertension"] ) Hypertension where Hypertension.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months )
define "Qualifying Encounters": ( ( [Encounter: "Office Visit"] union [Encounter: "Annual Wellness Visit"] union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"] union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"] union [Encounter: "Home Healthcare Services"] union [Encounter: "Online Assessments"] union [Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter where ValidEncounter.period.toInterval() during day of "Measurement Period"
define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters"
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "Has Hospice Services": exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and InpatientEncounter.period.toInterval() ends during day of "Measurement Period" ) or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment where HospiceAssessment.value ~ "Yes (qualifier value)" and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period" ) or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" )
define "Pregnancy or Renal Diagnosis": ( [Condition: "Pregnancy"] union [Condition: "End Stage Renal Disease"] union [Condition: "Kidney Transplant Recipient"] union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"
define "End Stage Renal Disease Procedures": ( ( [Procedure: "Kidney Transplant"] union [Procedure: "Dialysis Services"] ).isProcedurePerformed ( ) ) ESRDProcedure where ESRDProcedure.performed.toInterval ( ) ends on or before end of "Measurement Period"
define "End Stage Renal Disease Encounter": ( ( [Encounter: "ESRD Monthly Outpatient Services"] ).isEncounterPerformed ( ) ) ESRDEncounter where ESRDEncounter.period.toInterval ( ) starts on or before end of "Measurement Period"
define "Has Criteria Indicating Frailty": exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrder()) FrailtyDeviceOrder where FrailtyDeviceOrder.doNotPerform() is not true and FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ( (([Observation: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed where EquipmentUsed.value as Concept in "Frailty Device" and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period" ) or exists ( ([Condition: "Frailty Diagnosis"]) FrailtyDiagnosis where FrailtyDiagnosis.prevalenceInterval() overlaps "Measurement Period" ) or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter where FrailtyEncounter.period.toInterval() overlaps "Measurement Period" ) or exists ( (([Observation: "Frailty Symptom"]).isSymptom()) FrailtySymptom where FrailtySymptom.effective.toInterval() overlaps "Measurement Period" )
Outpatient Encounters with Advanced Illness
define "Outpatient Encounters with Advanced Illness": (( [Encounter: "Outpatient"] union [Encounter: "Observation"] union [Encounter: "Emergency Department Evaluation and Management Visit"] union [Encounter: "Nonacute Inpatient"] ).isEncounterPerformed()) OutpatientEncounter where exists ((OutpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness") and OutpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"]
Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service
define "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service": exists ( from "Outpatient Encounters with Advanced Illness" OutpatientEncounter1, "Outpatient Encounters with Advanced Illness" OutpatientEncounter2 where OutpatientEncounter2.period ends 1 day or more after day of end of OutpatientEncounter1.period return OutpatientEncounter1 )
Has Inpatient Encounter with Advanced Illness
define "Has Inpatient Encounter with Advanced Illness": exists ( ( ([Encounter: "Acute Inpatient"]).isEncounterPerformed()) InpatientEncounter where exists ((InpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness") and InpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] )
Has Dementia Medications in Year Before or During Measurement Period
define "Has Dementia Medications in Year Before or During Measurement Period": exists (( ([MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication where DementiaMedication.doNotPerform is not true and CMD."MedicationRequestPeriod" ( DementiaMedication ) overlaps Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] )
Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty
define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty": ( AgeInYearsAt(date from end of "Measurement Period")in Interval[66, 80] and "Has Criteria Indicating Frailty" and ( "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service" or "Has Inpatient Encounter with Advanced Illness" or "Has Dementia Medications in Year Before or During Measurement Period" ) ) or ( AgeInYearsAt(date from end of "Measurement Period")>= 81 and "Has Criteria Indicating Frailty" )
Is Age 66 or Older Living Long Term in a Nursing Home
define "Is Age 66 or Older Living Long Term in a Nursing Home": AgeInYearsAt(date from end of "Measurement Period" )>= 66 and ( ( Last( (([Observation: "Housing status"]).isAssessmentPerformed()) HousingStatus where HousingStatus.effective.toInterval() ends on or before end of "Measurement Period" sort by end of effective.toInterval() asc )) LastHousingStatus where LastHousingStatus.value ~ "Lives in a nursing home (finding)" ) is not null
Has Palliative Care in the Measurement Period
define "Has Palliative Care in the Measurement Period": exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period" )
define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period"
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
Value set Preventive Care Services Established Office Visit, 18 and Up
Value set Preventive Care Services Initial Office Visit, 18 and Up
Value set Chronic Kidney Disease, Stage 5
Value set ESRD Monthly Outpatient Services
Value set Emergency Department Evaluation and Management Visit
National Committee for Quality Assurance
Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period
In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record. Do not include BP readings taken during an acute inpatient stay or an ED visit. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled". If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS165v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).
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High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2021). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults >= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022). HBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the US; a person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of >= 160 mmHg could be effective and cost-saving (Moran, 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mmHg compared to a SBP goal of <140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.
U.S. Preventive Services Task Force (USPSTF) (2021): - The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017): - For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) - For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)). American College of Physicians and the American Academy of Family Physicians (2017): - Initiate or intensify pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, Quality of evidence: low) - Initiate or intensify pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, Quality of evidence: moderate) American Diabetes Association (2021): - For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15 percent), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: C) - For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15 percent), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A)
Patients 18-85 years of age by the end of the measurement period who had a visit during the meaurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period
Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period