Abstract
High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries. Hypertension control remains a challenge, especially in low-resource settings. One approach to improvement is the prioritization of patient-centered care. However, consensus on the outcomes that matter most to patients is lacking. We aimed to define a standard set of patient-centered outcomes for evaluating hypertension management in low- and middle-income countries. The International Consortium for Health Outcomes Measurement convened a Working Group of 18 experts and patients representing 15 countries. We used a modified Delphi process to reach consensus on a set of outcomes, case-mix variables, and a timeline to guide data collection. Literature reviews, patient interviews, a patient validation survey, and an open review by hypertension experts informed the set. The set contains 18 clinical and patient-reported outcomes that reflect patient priorities and evidence-based hypertension management and case-mix variables to allow comparisons between providers. The domains included are hypertension control, cardiovascular complications, health-related quality of life, financial burden of care, medication burden, satisfaction with care, health literacy, and health behaviors. We present a core list of outcomes for evaluating hypertension care. They account for the unique challenges healthcare providers and patients face in low- and middle-income countries, yet are relevant to all settings. We believe that it is a vital step toward international benchmarking in hypertension care and, ultimately, value-based hypertension management.
Highlights
High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries
Behavior change and pharmacotherapy are effective treatments for hypertension, among those diagnosed with hypertension, only 20% achieve blood pressure (BP) control in low- and middle-income countries (LMICs) compared with 42% in
The International Consortium for Health Outcomes Measurement (ICHOM) is a nonprofit organization that was founded in 2012 with the aim of encouraging the healthcare community to focus on value for the patient, where value is defined as the health outcomes achieved relative to the cost of achieving these outcomes.[11]
Summary
High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries. We aimed to define a standard set of patient-centered outcomes for evaluating hypertension management in low- and middle-income countries. We present a core list of outcomes for evaluating hypertension care They account for the unique challenges healthcare providers and patients face in low- and middleincome countries, yet are relevant to all settings. The International Consortium for Health Outcomes Measurement (ICHOM) is a nonprofit organization that was founded in 2012 with the aim of encouraging the healthcare community to focus on value for the patient, where value is defined as the health outcomes achieved relative to the cost of achieving these outcomes.[11] ICHOM achieves this aim by focusing on 3 areas: developing condition-specific Standard Sets with a focus on priorities of care identified by patients, supporting the implementation of these Sets, and enabling the benchmarking of outcomes between providers at a global level. ICHOM is piloting the feasibility of collecting data from multiple international institutions with the aim of understanding outcome variation to improve care for patients.[15]
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