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Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care

Publication ,  Journal Article
Henderson, W; Bosworth, HB; Voils, CI; Dudley, TK; McCant, FA; Gentry, PW; Oddone, EZ
Published in: Journal of Clinical Outcomes Management
March 1, 2005

• Objective: To develop a valid, reproducible scale that quantifies a provider's reaction to uncontrolled blood pressure. • Design: Retrospective chart review. • Setting and participants: 70 patients with hypertension who were treated with antihypertensive medication at the Durham Veterans Affairs Medical Center primary care clinic. • Methods: Three raters blinded to each other's assessments rated each patient visit using the hypertension quality of care scale. This scale includes 4 categories reflecting the extent of provider recognition of elevated blood pressure and action to lower it (0: blood pressure not recorded at visit; 1: blood pressure not controlled, not mentioned in the medical record, and nothing further done; 2: blood pressure not controlled, mentioned in the medical record, but nothing further done; 3: blood pressure not controlled and the provider acted in some manner to lower it). • Results: Providers failed to recognize or act on inadequately controlled blood pressure at 48% of visits. The average frequency of scores for all raters was 2.9% (no blood pressure recorded), 30.5% (blood pressure recorded but not mentioned), 14.3% (blood pressure recorded, provider recognized elevation, but no action), and 25.3% (provider acted to lower blood pressure); blood pressure was adequately controlled in 27.1% of patients. Inter-rater agreement was excellent (Kendall's W = 0.92). Scale scores were moderately related to the extent of systolic blood pressure elevation (r = 0.29, averaged across raters). • Conclusion: The scale demonstrated excellent interrater agreement and moderate correlation with elevation in systolic blood pressure. The scale could be used to measure the effectiveness of interventions designed to prompt providers to respond to inadequately controlled hypertension.

Duke Scholars

Published In

Journal of Clinical Outcomes Management

ISSN

1079-6533

Publication Date

March 1, 2005

Volume

12

Issue

3

Start / End Page

147 / 150

Related Subject Headings

  • General & Internal Medicine
 

Citation

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Henderson, W., Bosworth, H. B., Voils, C. I., Dudley, T. K., McCant, F. A., Gentry, P. W., & Oddone, E. Z. (2005). Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care. Journal of Clinical Outcomes Management, 12(3), 147–150.
Henderson, W., H. B. Bosworth, C. I. Voils, T. K. Dudley, F. A. McCant, P. W. Gentry, and E. Z. Oddone. “Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care.” Journal of Clinical Outcomes Management 12, no. 3 (March 1, 2005): 147–50.
Henderson W, Bosworth HB, Voils CI, Dudley TK, McCant FA, Gentry PW, et al. Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care. Journal of Clinical Outcomes Management. 2005 Mar 1;12(3):147–50.
Henderson, W., et al. “Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care.” Journal of Clinical Outcomes Management, vol. 12, no. 3, Mar. 2005, pp. 147–50.
Henderson W, Bosworth HB, Voils CI, Dudley TK, McCant FA, Gentry PW, Oddone EZ. Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care. Journal of Clinical Outcomes Management. 2005 Mar 1;12(3):147–150.

Published In

Journal of Clinical Outcomes Management

ISSN

1079-6533

Publication Date

March 1, 2005

Volume

12

Issue

3

Start / End Page

147 / 150

Related Subject Headings

  • General & Internal Medicine