Extra
information contained in doctors’ notes changed the assessment
of whether or not high blood pressure was controlled for a given patient
in fewer than 2 percent of the cases examined by Ann Borzecki, M.D.,
M.P.H., of the Bedford Veterans Affairs Medical Center and colleagues.
Their study
was published in the American Journal of Managed Care.
“If valid blood pressure data were available in automated form,
this would make evaluations of blood pressure control and quality of hypertension
care more useful by encompassing more cases and allowing more timely feedback
of information to providers, so that corrective actions would be more likely,” Borzecki
explains.
More than 50 million Americans have high blood pressure.
Despite readily available therapies to treat the condition, most hypertension
patients
don’t have their blood pressure under control.
Borzecki and colleagues compared the information on blood
pressure in databases and doctors’ notes at 10 VA hospital sites
around the country. The researchers examined blood pressure readings
in records
from 981 patients,
representing 6,097 medical visits.
Blood pressure measurements were recorded in either a
computerized database or doctors’ notes for 71 percent of the visits. Nurses probably took
most of the database measurements as part of a regular “intake” procedure,
the researchers say. In 11 percent of the visits, the blood pressure measurement
was recorded only in the doctor’s notes.
Blood pressure readings differed about half the time when
separate readings were recorded in the database and doctor’s notes.
Doctors were more apt to take their own reading for their notes if the
intake measurement
indicated high blood pressure.
Despite this, the database readings alone give an accurate
picture of a patient’s blood pressure control, Borzecki and colleagues
note. Patients would have been incorrectly diagnosed as having uncontrolled
blood pressure in only 48 of the visits.
The researchers say the VA’s clinical computerized data system that
captures blood pressure readings “could be easily adopted by other
settings.”
The study was supported by the Department of Veterans Affairs Health Services
Research and Development Service.
