Abstract 15805: Content Validity of a Measurement Tool to Assess Provider Concordance to the 2017 High Blood Pressure Clinical Practice Guidelines

Abstract

Introduction: The AHA/ACC 2017 High Blood Pressure clinical practice guidelines included numerous changes, including a new definition of hypertension (≥130/80 mm Hg) and lower thresholds for medication initiation, that may be challenging for clinicians to adopt. Developing and validating a tool to measure provider compliance to the guidelines is valuable for ascertaining compliance as a metric of healthcare quality. Methods: A five-step process was conducted. 1) Constructing items : 31 items that include five domains (screening, lifestyle, drug therapy, follow-up, laboratory) were compiled by the study investigators from the 2017 guideline. 2) Expert evaluation : A panel of five physicians with expertise in hypertension management reviewed and scored the items on how well they match to the guideline on a scale of 1 to 4 (1=does not match at all, 2=matches somewhat, 3=matches, 4=matches very well). The panel subsequently met face-to-face and came to a consensus on items that received <3 score by any reviewer. 3) Refining items : Using information gathered during step 2, the tool was subsequently modified. 4) Expert reevaluation : experts rescored the match of the refined items to the guideline. 5) Validity score : Item Content Validity Index (I-CVI) was calculated as the proportion of experts who gave a score of ≥3 for an item and Scale Content Validity Index (S-CVI) as the proportion of items that received a score of ≥3 out of total items. I-CVI and S-CVI ≥0.80 were included in the final tool. Results: Twelve out of 31 items had a score of <3 by at least one panel member. After the panel discussion, the contents of 9 of the 12 items were modified. The expert panel eliminated 2 of the 12 items because they were not clearly recommended in the guidelines. One item with ICV-I <80% was eliminated. Each of the remaining 28 items had I-CVI ≥80% (10 had 80% and 18 had 100% I-CVI) and were included in the final tool. S-CVI for all items was 91%. Of 28 items, 3 were related to screening, 1 to lifestyle, 17 to drug therapy, 1 to laboratory, and 7 to follow-up. Conclusions: We developed and refined a measurement tool to evaluate provider level of compliance to hypertension treatment guidelines. This tool will be applied to identify patients at risk of receiving care inconsistent with current guidelines.