Regarding the metric we publlshed in AJOG 2022, I received the following query:
Your SMFM statement defines the metric denominator as persistent HTN, which is defined as severe range HTN which is not documented to resolve within 15 minutes. Yet example B in Figure 1, which is properly noted to be "Multiple" episodes of HTN, is colored yellow which denotes persistent HTN, despite the fact that each episode resolves within 15 minutes. Is SMFM advocating for treatment even when the repeat BP has normalized? Or would a repeat BP not be warranted if the BP rises within 1 hour, which then changes the definition of persistent HTN?
Reply:
Dear Dr xx,
Sorry this is confusing.
The example B is intended to capture a scenario that is very difficult to describe in text.
We attempted to describe it in the measure description, last sentence of paragraph describing the denominator, on page B3:
Repeated severe HTN observations at 15 to 60 minutes after the first severe HTN observation are considered part of a single episode, even if they are inter- spersed with normal BPs or nonsevere hypertension measurement.
combined with the numerator specification in Table 1:
A BP that is not severe HTN is recorded and subsequent BPs are not in the severe range within 60 min of episode onset
So example B would satisfy the numerator criteria (i.e. credit for timely treatment) if that N is at 59 minutes (or 60 if you interpret "within 60 min" to mean "less than or equal to 60 min).
The numerator would not be met if the S at 50 minutes has the first subsequent N at 61 minutes.
Glad to hear that it sounds like you are trying to operationalize the metric.
If your hospital is on Epic, my understanding is that they have built this metric into their foundation system.
You may be able to save some development headache by looking for a Dashboard that includes this metric.
If you are not on Epic, then, like me, you will need to do some programming, which is a bear but it is do-able.
Regards,
Andy Combs
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Andrew Combs
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