Quality measurement as a prerequisite for improving hypertension control in an academic medical center.

BACKGROUND: Quality of care provided by the outpatient hypertension unit of a general hospital was measured using quality indicators (QIs) derived from guidelines. HYPOTHESIS: Measuring provided quality of care is an important step for improving it.
METHODS: We enrolled 1206 patients with hypertension, 626 men and 580 women, with a mean age of 55.33 ± 12.08 years. Median follow-up was 47 months (minimum: 6 months, maximum: 349 months, interquartile range). We calculated the percentage of patients who achieved the targets of controlling blood pressure (BP), total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, glucose, uric acid, potassium, sodium, creatinine clearance, Sokolow-Lyon index, and left ventricle hypertrophy in echo between the first and the last visit. Patient satisfaction and the incidence of coronary artery disease (CAD), myocardial infarction (MI), and stroke were evaluated as outcome indicators.
RESULTS: The BP was controlled in 40% of patients at the end of the study, compared with 11% at the first visit. We did not manage to achieve significant improvement for other QIs. A wide range of hypertensive patients and lack of a quality improvement program are the main reasons for low control rate. During follow-up, we obtained the increased incidence of cardiovascular events by outcome indicators such as CAD, MI, and stroke.
CONCLUSIONS: Quality measurement shows us that the quality of provided care needs further improvement. Although we succeeded in controlling BP in 40% of patients, we did not manage to improve the other QIs. Modifying our structure and process components, we are working on improving outcome by achieving better control of QIs.