Developing Capacity to Measure Undiagnosed Hypertension in New York
Submission Date: May 2016
Entry Type: Case Study
State/Territory Submitted on the Behalf of: New York
States/Territories Involved: New York
Funding Source: CDC
CDC Funding:Yes
CDC Funding (Specified):(1305) State Public Health
Domain Addressed:Community-Clinical Linkages, Health Systems Strategies
Public Health Issue:Hypertension, or high blood pressure, is a major risk factor for heart disease and stroke and is also the greatest contributor to racial disparities in life expectancy.
Potentially millions of people with uncontrolled high blood pressure are seen by health care professionals each year but remain undiagnosed and consequently untreated.
Analyzing large data sets on primary care of hypertension can help a health department understand the scope of the problem of undiagnosed hypertension and work with health care providers to improve care for adults with hypertension.
Project Objectives:Objectives
Objectives of Pilot #1:
- Develop specifications for 3 high blood pressure metrics (prevalence, control and undiagnosed) to calculate for a sub-population (Albany County)
- Evaluate the quality and completeness of HIE data and record challenges in calculating the metrics
- Explore the feasibility of stratified analyses to identify high need populations within Albany County
Objectives of Pilot #2:
- Develop measures of hypertension, including undiagnosed hypertension, within informatics platform integrated with HIE.
- Calculate measures of hypertension for a 20 county area served by the Hixny HIE and complete stratified analyses (patientās county, facility type, electronic health record vendor, performance year, etc.).
- Evaluate factors contributing to data completeness and utility of data for public health surveillance.
Albany, New York physicians requested information on the rate of undiagnosed hypertension to support a collaborative project with the Albany County Health Department. This request led the New York State Department of Health (DOH) to identify data sources to better understand the scope of the public health problem of undiagnosed hypertension in New York and to support primary care providers in identifying patients with hypertension.
New York funds a network of Regional Health Information Organizations (RHIOs) which are multi-stakeholder collaborations that enable secure exchange of health information to support health care quality improvement. With DOH leadership support, primary care clinic de-identified data from Hixny, a RHIO serving a 19-county region, was analyzed and evaluated for completeness utilizing CDCās Guidelines for Evaluating Data Systems.
An initial pilot analysis used a sample of data extracted from the RHIO system for Albany County applying the JNC VII definition of undiagnosed hypertension and technical specifications from the National Quality Forum. A second pilot analyzed data from the entire 19 county region covered by Hixny and adjusted measure criteria based on the initial pilot to allow data from more practices to be reflected in the measures of undiagnosed hypertension.
Data/Other Information Collected:Additional information on data collection and definitions of measures used is available in this set of presentation slides from New York.
Impact/Accomplishments:The pilot identified over 8,000 adults meeting the definition of hypertension who had not yet been diagnosed.
The DOH demonstrated the ability to collaborate with a health information exchange (HIE) to measure the actual rate of undiagnosed hypertension. Hixny data gave the DOH the means to describe the clinical picture of a 19 county area representing 2.7 million residents including the potential undiagnosed hypertension rate.
The two pilots enabled the DOH to evaluate the quality and completeness of the RHIOās HIE data and draw conclusions that will guideĀ its data analysis for quality improvement activities related to hypertension and support continuing work with HIEs, including:
- It is feasible to adapt and apply nationally-endorsed quality measures for hypertension to HIE data such as the RHIOās and obtain local estimates for hypertension prevalence, control and undiagnosed hypertension in alignment with national estimates.
- The considerable variation in the quality and completeness of data from entities reporting to HIEs is an issue that DOH will focus on to improve their surveillance.
- Use of relaxed criteria for measurement enabled the HIE to be an actionable information source for undiagnosed hypertension and allowed data from an additional 17 electronic medical record vendors to be included without compromising the measure.
NY is now working with the RHIO to develop interactive dashboards that practices contributing data can use to identify patientās undiagnosed hypertension in their patient panel without the need to calculate the measure from their electronic health record.
NY is also working to develop tools within the RHIO to track the number of patients with undiagnosed hypertension who are later diagnosed and to pilot test alerts care providers or care coordinators can use to follow up on patients with undiagnosed hypertension.
Program Areas:Heart Disease and Stroke
State Contact Information:
New York
Ian Brissette, Director, Bureau of Chronic Disease Evaluation & Research
New York State Department of Health
518-473-4414
Ian.Brissette@health.ny.gov