Leadership Message: American Society of Hypertension–Designated Centers of Excellence: A New Initiative

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The American Society of Hypertension, Inc. (ASH) Board of Directors is pleased to announce a new program to assist patients who have difficult-to-treat hypertension. This program provides for a formal recognition by ASH for medical practices that have demonstrated excellence in treating patients with complex and resistant hypertension and its comorbidities. The program is focused on enhancing hypertension patient care and is designed to evaluate each medical practice against a professional set of criteria based on responses to a questionnaire and a site visit by experts in the field of clinical hypertension.

Role and Function of ASH-Designated Hypertension Centers

From the perspective of patients, the ASH-designated centers will provide multiple services including, but not limited to:

  • • Providing patients with access to centers focused on treating complicated and resistant hypertension and its comorbidities.
  • • Providing patients with confidence that the centers can provide the most effective treatment strategies based on current translational research in hypertension.
  • • Providing patients with assurance that the center has been recognized by ASH based on professional evaluation criteria.

From the perspective of the health care provider, the ASH-designated centers will:

  • • Promote and recognize the role and function of physicians who have achieved the designation as specialists in clinical hypertension.
  • • Provide a referral source for nonhypertension specialist physicians and other health care providers treating patients with complex and/or resistant hypertension and its comorbidities.
  • • Establish a national coordinating network of ASH-designated hypertension centers for physician and other health care provider access.
  • • Work toward appropriate reimbursement for health care professionals treating patients with complex hypertension and its comorbidities.
  • • Provide direct access to ASH educational activities.

In establishing ASH hypertension centers, we have also taken into consideration the perspectives of the clinical research–oriented physicians who are also likely to be involved with the training of young physicians to become hypertension specialists. Included in the initiative for these “academically inclined” centers are the following potential options:

  • • To provide centers with the opportunity to participate in hypertension clinical research studies, including the ASH National Hypertension Registry Initiative.
  • • To serve as an impetus to expand hypertension training programs at all levels.
  • • To utilize the outcomes of these studies to develop needs assessments for hypertension health care providers and develop appropriate educational activities.

We also hope and expect that ASH hypertension centers can collaborate with insurance providers and payors to establish collaborative and educational liaisons as well as provide standard criteria for effective management protocols in hypertension practice.

ASH-Designated Hypertension Centers Criteria

Hypertension centers will be accredited at 2 levels, with level II encompassing research and education. One over-arching criterion for accreditation of a hypertension center is that the facility will be directed by a physician who has received designation as a hypertension specialist by the hypertension specialist program of ASH.

Criteria for designation as an ASH level I hypertension center is shown in Table I, while criteria for an ASH level II hypertension center is shown in Table II.

Table I.   Criteria for Designation as a Type I American Society of Hypertension (ASH)–Designated Hypertension Center of Excellence
Director must be an ASH-designated specialist in clinical hypertension
At least 50% of the practice devoted to patients with hypertension and related disorders
Certified personnel in recording blood pressure and maintaining equipment for both the center and self-monitoring for patients
Perform and interpret 24-hour ambulatory blood pressure
Available for cardiovascular risk assessment, including, but not limited to, 2-dimensional/Doppler echocardiography, exercise testing, measurement of arterial compliance, ankle-brachial index measurements, and carotid duplex ultrasonography
Participation in investigator-initiated research and/or in appropriate multicenter trials and observational studies
Recognition as a referral and treatment resource for complex/resistant hypertension, secondary hypertension, and alternative therapies
Ongoing quality improvement in accord with standardized quality performance guidelines
Ongoing participation in hypertension educational activities
Table II.   Criteria for Designation as a Type II American Society of Hypertension (ASH)–Designated Hypertension Center of Excellence
Meets all level I criteria shown in Table I
 Center director should hold a senior academic appointment
 Should have the ability to perform extensive multispecialty examination and treatment
 Should be involved in research, including basic and/or applied
 Involvement in the training of those interested in hypertension as a specialty
 Involvement in the publication of scholarly articles related to the field of hypertension and related disorders

Application Process to Become an ASH-Designated Hypertension Center

Medical practices that wish to become an ASH-designated hypertension center of excellence will be required to submit a formal application to commence the process. A formal ASH application form is in the process of development. Applications will be received on an ongoing basis and they will be reviewed by the review committee as they are received.

Appointment of a Review Committee for the ASH-Designated Hypertension Centers Program

ASH will appoint a review committee of ASH designated specialists in clinical hypertension for a 2-year term to review and accept applications on a preliminary basis from medical practices that wish to become ASH-designated hypertension centers of excellence.

ASH will appoint a large pool of designated specialists in clinical hypertension for a 2-year term from different regions of the United States to serve as on-site evaluators of centers whose applications have been accepted by the review committee on a preliminary basis.

Process to Designate a Center as an ASH-Designated Hypertension Center

Physicians and clinics interested in becoming an ASH-designated hypertension center will be required to submit an application for evaluation by the review committee. For sites/practices found to be appropriate at this initial level of review, an on-site center review and evaluation will be scheduled and conducted by 2 ASH-designated reviewers.

Term for Approval as an ASH-Designated Hypertension Center

  •  Medical practices approved as level one or level II ASH-designated centers of excellence will be approved for a 5-year term.
  •  Approved centers have the option one year before the conclusion of their approved term to apply for re-designation by submitting a self-study, as well as scheduling an on-site evaluation.

Benefits for an ASH-Designated Hypertension Center

Practices and clinics designated as an ASH hypertension center of excellence will be recognized in a number of ways, including the presentation of a plaque and decals confirming designation to patients and visitors to the practice, listing in a national roster of ASH-designated hypertension centers of excellence on the ASH Web site, provision to have the opportunity to participate in clinical hypertension research programs, receive educational materials including the ASH patient informational brochures. Finally, centers will benefit from ASH promotion and marketing of our newly designated centers of excellence.

Conclusions

ASH is enthusiastic about this new initiative to designate level I and level II hypertension centers of excellence. The center designation will improve the visibility of the ASH specialists and should facilitate accessibility to clinical hypertension specialists for patients as well as their referring physicians. We look forward to initiating numerous level I and II centers in the United States during the course of this next year.

Acknowledgments:

Dr William White is President-Elect of the American Society of Hypertension and Dr John Kostis served as Chair of the Subcommittee for the Hypertension Centers of Excellence initiative.

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