Blood pressure recording bias during a period when the quality and outcomes framework was introduced

ABSTRACT The 2004 UK Quality and Outcomes Framework (QOF) remunerates general practitioners for achieving a target blood pressure (BP) of ⩽150/90 mm Hg for patients with ischaemic heart

disease, stroke and hypertension. Using the DIN-LINK GP database, we investigated whether introducing the target altered BP recording. We extracted 3 164 189 BP measurements from 236 467

patients, with the above diagnoses from 2000 to 2005. Treatment was assessed by Read codes indicating prescriptions for antihypertensive drugs. Over this period, recorded systolic BP (SBP)

fell: 36% had an SBP >150 mm Hg in 2000–2001, and only 19% in 2004–2005. However, there was a trend towards recording systolic values just below, rather than just above the 150 cut-off.

In 2000–2001, 2.3% of patients had 148–149 recorded and 1.8% had 151–152. In 2004–2005, the figures were 4.2 and 1.3%, respectively. By smoothing the distribution we estimate that the true

percentage of patients with SBP>150 mm Hg in 2004–2005 was 23%, rather than the 19% recorded. Moreover, patients with a recorded SBP=148–149 were more likely to have a recorded diastolic

BP⩽90 (93%) than patients with SBP=151–152 (78%). However, patients just below the 150 mm Hg cut-off received more antihypertensive treatment than those just above it (odds ratio=1.20, 95%

confidence interval 1.01–1.41). We conclude that blood pressure levels in UK primary care have continued to fall through the introduction of QOF, offering significant public health benefits

in the future. This fall has been exaggerated due to values being clustered just below the QOF target, but there is no evidence of adverse effects of this on clinical management. Access

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Google Scholar  Download references ACKNOWLEDGEMENTS We acknowledge with gratitude the general practitioners who provided the data to the DIN-LINK. We are grateful to Cegedim Strategic Data

(Woking, Surrey, UK) for their technical assistance with DIN-LINK database and for their helpful support. IMC and SDW were funded by a grant from the BUPA Foundation. AUTHOR INFORMATION

AUTHORS AND AFFILIATIONS * Division of Community Health Sciences, St George's, University of London, London, UK I M Carey, C M Nightingale, S DeWilde, T Harris, P H Whincup & D G

Cook Authors * I M Carey View author publications You can also search for this author inPubMed Google Scholar * C M Nightingale View author publications You can also search for this author

inPubMed Google Scholar * S DeWilde View author publications You can also search for this author inPubMed Google Scholar * T Harris View author publications You can also search for this

author inPubMed Google Scholar * P H Whincup View author publications You can also search for this author inPubMed Google Scholar * D G Cook View author publications You can also search for

this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to I M Carey. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Carey, I.,

Nightingale, C., DeWilde, S. _et al._ Blood pressure recording bias during a period when the Quality and Outcomes Framework was introduced. _J Hum Hypertens_ 23, 764–770 (2009).

https://doi.org/10.1038/jhh.2009.18 Download citation * Received: 14 November 2008 * Revised: 28 January 2009 * Accepted: 30 January 2009 * Published: 12 March 2009 * Issue Date: November

2009 * DOI: https://doi.org/10.1038/jhh.2009.18 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is

not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * blood pressure * measurement bias * quality and

outcomes * general practice