Including, but not limited to, solo/small physician offices, group practices, ambulatory care centers, health systems, public health sites, accountable care organizations, and clinically integrated networks that diagnose and treat patients with HBP. ACC indicates American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CDU, care delivery unit; CVD, cardiovascular disease; DBP, diastolic blood pressure; e-health, healthcare services provided electronically via the Internet; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; m-health, practice of medicine and public health supported by mobile devices; PCE, pooled cohort equations; PM, performance measure; QM, quality measure; RCT, randomized controlled trial; SBP, systolic blood pressure; SM, structural measure; and USPSTF, US Preventive Services Task Force. Table 8. Continued Measure No. Measure Title Attribution Rationale for Creating New Measure 14 Esteban Perla, MPH, Team Lead, Quality Measurement Amelia Scholtz, PhD, Publications Manager, Science, Education, Quality, and Publishing American College of Cardiology/ American Heart Association Abdul R. Abdullah, MD, Director, Guideline Science and Methodology Rebecca L. Diekemper, MPH, Guideline Advisor, Perfor- mance Measures American Heart Association Ivor J. Benjamin, MD, FAHA, President Nancy Brown, Chief Executive Officer Mariell Jessup, MD, FAHA, Chief Science and Medical Officer Rose Marie Robertson, MD, FAHA, Deputy Chief Sci- ence and Medical Officer Gayle R. Whitman, PhD, RN, FAHA, FAAN, Senior Vice President, Office of Science Operations Radhika Rajgopal Singh, PhD, Director, Science and Medicine, Office of Science Operations Anne Leonard, MPH, RN, FAHA, Senior Science and Medicine Advisor, Office of Science Operations Melanie Shahriary, RN, BSN, Senior Manager, Perfor- mance Metrics, Quality and Health IT Jody Hundley, Production and Operations Manager, Sci- entific Publications, Office of Science Operations ARTICLE INFORMATION This Physician Performance Measurement Set (PPMS) and related data specifica- tions were developed by the Physician Consortium for Performance Improve- ment (the Consortium), including the American College of Cardiology (ACC), the American Heart Association (AHA), and the American Medical Association (AMA), to facilitate quality-improvement activities by physicians. The perfor- mance measures contained in this PPMS are not clinical guidelines, do not es- tablish a standard of medical care, and have not been tested for all potential applications. Although copyrighted, they can be reproduced and distributed, without modification, for noncommercial purposes for example, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the performance measures for commercial gain, or incorporation of the performance measures into a product or service that is sold, licensed, or distributed for commercial gain. Commercial uses of the PPMS require a license agreement between the user and the AMA (on be- half of the Consortium) or the ACC or the AHA. Neither the AMA, ACC, AHA, the Consortium, nor its members shall be responsible for any use of this PPMS. The measures and specifications are provided as is without warranty of any kind. Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of the code sets. The AMA, the ACC, the AHA, the National Committee for Quality Assurance (NCQA), and the Physician Consor- tium for Performance Improvement (PCPI) and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT) or other cod- ing contained in the specifications. CPT contained in the measures specifications is copyright 2004 2012 American Medical Association. LOINC copyright 2004 2012 Regenstrief Insti- tute, Inc. This material contains SNOMED CLINICAL TERMS (SNOMED CT) copy- right 2004 2012 International Health Terminology Standards Development Organization. All rights reserved. This document underwent a 14-day peer review between March 18, 2019, and April 1, 2019, and a 30-day public comment period between March 18, 2019, and April 16, 2019. The American Heart Association and the American College of Cardiology make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or busi- ness interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential con- flicts of interest. This document was approved by the American College of Cardiology Clinical Policy Approval Committee and the American Heart Association Science Advisory and Coordinating Committee in June 2019; by the American Heart Association Executive Committee on August 9, 2019; and by the American Medical Associa- tion and the Preventive Cardiovascular Nurses Association on July 25, 2019. Supplemental materials are available with this article at https://www. ahajournals.org/doi/suppl/10.1161/HCQ.0000000000000057. This article has been copublished in the Journal of the American College of Cardiology. Copies: This document is available on the websites of the American College of Cardiology (www.acc.org) and the American Heart Association (professional. heart.org). A copy of the document is also available at https://professional.heart. org/statements by selecting the Guidelines & Statements button. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer. com. The expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guide- lines development, visit https://professional.heart.org/statements. Select the Guidelines & Statements drop-down menu near the top of the webpage, then click Publication Development. 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HBP Measure Set Performance Measures for HBP Short Title: PM-1a: ACC/AHA Stage 2 HBP Control SBP <140 mmHg (Harmonizing Measure) PM-1a: Percentage of Patients 18 to 85 years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP and Whose SBP Was <140 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP with SBP <140 mmHg (harmonizes with current performance measure Controlling High Blood Pressure in widespread use) Numerator Patients with SBP <140 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications. This performance measure harmonizes with NCQA HEDIS 2019, ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs. National average rates of performance have been consistently <70% for several years for HEDIS. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 1. BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-y ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. (Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record,69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set. 4) NQF Measure 0018 Controlling High Blood Pressure (NCQA).22 Additional note: 2017 Hypertension Clinical Practice Guidelines relies on average BP readings. NCQA HEDIS relies on most recent BP reading: The member is numerator compliant if the BP is <140/90 mmHg. The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing). If there are multiple BPs on the same date of service, use the lowest systolic and diastolic BP on that date as the representative BP. ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 21 Appendix A. Continued Short Title: PM-1b: ACC/AHA Stage 2 HBP Control SBP <130 mmHg (Enhancing Measure) PM-1b: Percentage of Patients 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP with SBP <130 mmHg (harmonizes with current performance measure Controlling High Blood Pressure in widespread use) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications. This performance measure enhances NCQA HEDIS 2019, ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 1. BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. (Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record.69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set. 4) NQF Measure 0018 Controlling High Blood Pressure (NCQA).22 Additional note: 2017 Hypertension Clinical Practice Guidelines relies on average BP readings. NCQA HEDIS relies on most recent BP reading: The member is numerator compliant if the BP is <140/90 mmHg. The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing). If there are multiple BPs on the same date of service, use the lowest systolic and diastolic BP on that date as the representative BP. ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NMA, National Medical Association; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 22 Appendix A. Continued Short Title: PM-2: ACC/AHA Stage 1 HBP Control SBP <130 mmHg (Harmonizing Measure) PM-2: Percentage of Patients 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 1 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 1 HBP with SBP <130 mmHg (harmonizes with current performance measure Controlling High Blood Pressure for ACC/AHA stage 2 HBP currently in widespread use) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 1 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications. This performance measure harmonizes and supplements the existing measure for stage 2 with NCQA HEDIS 2019 (currently in draft form for public comment), ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs. There is currently no HEDIS or other standardized measurement of a national average rate of performance for stage 1 HBP. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. 