Validation of a Health System Measure to Capture Intensive Medication Treatment of Hypertension in the Veterans Health Administration

Abstract

IMPORTANCE Blood pressure (BP) targets are the main measure of high-quality hypertension care in health systems. However, BP alone does not reflect intensity of pharmacological treatment, which should be carefully managed in older patients.OBJECTIVES To develop and validate an electronic health record (EHR) data-only algorithm using pharmacy and BP data to capture intensive hypertension care (IHC), defined as 3 or more BP medications and BP less than 120 mm Hg, and to identify conditions associated with greater IHC, either through greater algorithm false-positive IHC, or by contributing clinically to delivering more IHC. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study was conducted among 319 randomly selected patients aged 65 years or older receiving IHC from the Veterans Health

Clinical outcomes of modifying hypertension treatment intensity in older adults treated to low blood pressure

“…We selected all conditions potentially associated with our treatment and/or outcomes of interest, as well as markers of patient sickness or frailty. To capture antihypertensive treatment, we applied an algorithm that we previously validated in older Veterans, which uses VA and Medicare Part D pharmacy fills to determine the most likely antihypertensive medication on any day 24 . We standardized doses to HDDs, allowing comparison across medications 20 .…”

“…To capture antihypertensive treatment, we applied an algorithm that we previously validated in older Veterans, which uses VA and Medicare Part D pharmacy fills to determine the most likely antihypertensive medication on any day. 24 We standardized doses to HDDs, allowing comparison across medications. 20 We defined one HDD as half the maximum beneficial dose demonstrated in trials (Table S2), [25][26][27] and aggregated the standardized doses to obtain total dose.…”

A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data

“…A previous study described the sampling strategy for this cohort of moderately to intensely treated veterans 13 selected from a national sample of older (Ն65 years) Veterans Health Administration patients with hypertension (International Classification of Diseases, Ninth Revision code 401.x), receiving primary care over 2 years (from July 1, 2011, to June 30, 2013), taking 3 or more BP medications, and having a systolic BP less than 120 mm Hg for 2 or more consecutive visits. The strategy ensured that we had an adequate number of visits while receiving multiple BP medications to validate.…”

“…An algorithm was previously developed and validated to assess treatment intensity measured as the number of medications based only on reliable administrative pharmacy fill data within a complex electronic medical record and health care data system. 13 The goal of the present study was to (1) extend the method to capture daily dose, defined as moderate HDD, for each BP-lowering medication; (2) validate that the total HDDs calculated from pharmacy data across multiple medications reflect the intensity of patients' overall antihypertension medication regimens; and (3) describe the association between the new HDD measure and the traditional medication count.…”

Factors associated with antihypertensive treatment intensification and deintensification in older outpatients

“…In prior work focused on only those patients with aggressive hypertension treatment (systolic blood pressure [SBP] <120 ​mmHg and ≥3 antihypertensive medications), we developed a new measure to assess the intensity of hypertension pharmacological treatment (i.e., total daily dose) on any given day based on pharmacy fill data [ 4 , 5 ]. Unlike previous methods, this new measure uses standardized doses based on trial evidence-based beneficial doses used to treat hypertension.…”