Achieving the BpTRUth: emergency department hypertension screening and the Centers for Medicare & Medicaid Services quality measure

Abstract

In 2012, the Centers for Medicare & Medicaid Services (CMS) instituted a Physician Quality Reporting System measure for screening and referring patients with elevated blood pressure (BP). The aims of this study were to (1) assess the reliability of ED triage BP as a metric to establish when the CMS threshold (≥120/80 mm Hg), and other clinically relevant BP thresholds (≥140/90 and ≥160/100 mm Hg) have been met, using BP measured with a highly accurate device (BpTRU) in the emergency department as the gold standard; and (2) determine whether correct identification varies by gender, race, or triage acuity. Using the BpTRU, we calculated the proportion of patients whose triage BP accurately indicated a need for further referral and treatment for hypertension according to three suggested BP thresholds (≥120/80, ≥140/90, and ≥160/100 mm Hg). Of 354 patients, the median age was 39 years, 48.9% were women, and 66.4% were White. At the three suggested BP thresholds (≥120/80, ≥140/90, and ≥160/100 mm Hg), 66.1%, 74.0%, and 88.8% of patients were confirmed to meet the CMS threshold, respectively. There were no differences by gender, race, or triage acuity. Emergency department triage BP would reliably identify elevated BP using the CMS threshold in up to two-thirds of those without known hypertension.

Keywords: Blood pressure; emergency medicine; health policy; measurement.