Justification for Change

Change Request

March 5, 2015

Information Collection Request: Million Hearts® Hypertension Control Challenge

(OMB no. 0920-0976, exp. date 7/31/2016)

Background and Justification

CDC is currently approved to collect information for three years to conduct annual Million Hearts® Hypertension Control Challenges in 2013, 2014, and 2015. The Challenge, under the authority of the America Creating Opportunities to Meaningfully Promote Excellence in Technology, Education and Science Reauthorization Act of 2010 (COMPETES Act), Public Law 111- 358, allows CDC to select and recognize Million Hearts® Hypertension Control Champions to motivate, inspire, and further the agency’s mission by attracting more interest and attention to hypertension control. Specifically, identifying and recognizing exemplary clinical practices will (a) lead to deeper understanding about how to achieve better control rates, (b) bring widespread attention to achievable exemplar rates, (c) motivate clinicians to strive for better hypertension control rates, and (d) bring prestige to a wide range of organizations that invest in hypertension control. CDC proposes to formally recognize a small number of Champions from the private sector, up to 30 annually, and develop translation documents that describe processes and sustainable systems that support exemplary clinical hypertension control rates. The 2013 Challenge was launched in August of 2013 and nine Champions were announced in February 2014. The 2014 Challenge was launched in August of 2014 and 30 Champions were announced in February 2015.

CDC collects three types of information to support the Challenge:

1. Web-based Million Hearts® Hypertension Control Champion Nomination Form. This form is used by clinicians or clinical programs to voluntarily self-nominate their or another practice or health care system for Million Hearts® recognition. CDC uses the information submitted on the nomination form to score nominees and identify up to 30 finalists for further consideration.

2. Million Hearts® Hypertension Control Champion Data Verification Form. This form facilitates review and verification of information submitted for finalists. CDC’s data collection contractor works with nominees to clarify inaccuracies or inconsistencies.

3. Million Hearts® Hypertension Control Champion Interview Guide. This form guides a discussion with each finalist to document the processes used to achieve success in controlling hypertension.

Based on experience with the information collection in 2014, CDC proposes minor changes to the Nomination Form for the 2015 cycle of information collection. The revised questions are included in:

• Attachment 3a (revised_3 04 2015)

Detailed Discussion of Changes

1. Clarification of “Name” in the Nominee information section of the form.

The revised form will permit clearer identification of the Practice or Provider being nominated for consideration as a Million Hearts® Hypertension Control Champion. Previously, it was not clear if the Practice or Provider was being nominated. This clarification is not expected to add any additional burden to nominators.

2. Addition of one new question on Population served by the nominee:

The new question is: “Percent of patients who have no health insurance”

The existing questions about the demographics of the nominee’s patient population did not address this traditionally underserved population very well. Previously, other nominators have reported this type of information in the “Other” category. CDC believes it will be more informative to capture this information systematically among all nominees. Since most health providers/systems already track this metric, including the additional question on the Nomination Form is expected to represent minimal burden to the nominator.

3. Hypertension Control section: Clearer specification of (a) the definition of “hypertension control” used by CDC for purposes of the Challenge, and (b) the clinical quality measure(s) used by nominees to assess hypertension control

For purposes of the Million Hearts® Hypertension Control Challenge, CDC defines “hypertension control” as a blood pressure reading < 140 mmHg systolic and <90 mmHg diastolic in patients aged 18 through 85 years with a previous diagnosis of hypertension. Initially, a measure of blood pressure control used by the National Quality Forum (NQF) — clinical quality measure NQF 0018 — met these criteria and was cited on the Million Hearts® Hypertension Control Champion Nomination Form as an accepted standard. However, as of December 2014, the measure specifications for NQF 0018 have changed with further delineation of blood pressure targets for selected subgroups of patients. The revised NQF 0018 measure is organized according to:

- Patients 18–59 years of age whose BP was <140/90 mm Hg
- Patients 60–85 years of age with a diagnosis of diabetes whose BP was <140/90 mm Hg
- Patients 60–85 years of age without a diagnosis of diabetes whose BP was <150/90 mm Hg

As a result, the revised NQF measure is no longer automatically equivalent to the definition for hypertension control used for the Million Hearts® Hypertension Control Challenge. CDC requests OMB approval to modify the Million Hearts® Hypertension Control Champion Nomination Form by including explanatory text or items to specify: (a) the definition of “blood pressure control” used for the Million Hearts® Challenge; (b) the clinical quality measure used by the nominee to assess hypertension control; and (c) whether the nominee has used the same measure during the current and previous reporting periods, or has adopted a different measure for the current reporting period. These modifications will allow CDC to verify that each applicant’s hypertension control measure meets the specified blood pressure control criteria, provide flexibility and clarity for respondents, allow for the determination if the current and previous blood pressure control values are comparable, and represent minimal burden to the nominator.

4. Hypertension Control section: Standardizing the method for calculating hypertension control rate

In the revised version of the form, some existing questions have been regrouped and presented in a table format to provide a more systematic approach for collecting and reviewing data. The table format improves information quality as the individuals conducting the validations will be clearly applying the same tabulation standards to all applicants. This makes is easier to reconcile all the numbers needed to determine hypertension control, and compare rates for different applicants, without increasing burden on the nominator.

The changes are intended to improve clarity and usability for respondents and to improve the quality of data submitted to CDC. The proposed changes do not alter the scope of the information collection, the number of respondents, the estimated burden per response, frequency of data collection, or the judging criteria.

CDC plans to begin administering the revised forms in 2015.  OMB approval is requested, effective immediately.

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