Hense H W, Koivisto A M, Kuulasmaa K, Zaborskis A, Kupsc W, Tuomilehto J
Institute of Epidemiology and Social Medicine, University Münster, Germany.
J Hum Hypertens. 1995 Dec;9(12):935-46.
Because of the general inavailability of reference standards, there exist no common procedures to assess the quality of blood pressure measurements in epidemiological population surveys. To approach this problem within the collaborative international WHO MONICA Project, a standardized assessment of BP measurement quality was developed and applied to the forty-seven baseline surveys of that project. The entire assessments were carried out in retrospect, that is, only after each population survey had been completed. The assessment was focused on the procedures of quality assurance and control as reportedly applied in each survey, and on quality indicators which were derived from the recorded blood pressure values of each survey. The definitions of specific quality assessment items were based on the MONICA project protocol and on sources in the pertinent literature. The available information on quality assurance and control procedures depended solely on self-reports by local survey organizers and on site visits, and was occasionally found to be at variance with the actual blood pressure recordings. Therefore, quality indicators derived from actual blood pressure recordings were far more informative and comparable between surveys. Each survey was rated as optimal, satisfactory, or unsatisfactory with regard to single quality items and these single scores were used jointly to compute a summary score of blood pressure measurement quality for each survey. This summary score indicated that 39 out of 47 MONICA baseline surveys showed optimal or satisfactory BP measurement quality. Limitations and potentials for improvement of quality assessments became apparent. We conclude that a standardized assessment of BP measurement quality in epidemiological population surveys seems feasible and propose that quality assessment methods similar to the ones suggested here become a routine part of future epidemiological analyses of blood pressure values and hypertension in populations. This should facilitate valid study comparisons.
由于缺乏通用的参考标准，在流行病学人群调查中不存在评估血压测量质量的通用程序。为了在世界卫生组织（WHO）的国际合作莫尼卡项目（MONICA Project）中解决这一问题，开发了一种标准化的血压测量质量评估方法，并将其应用于该项目的47次基线调查。整个评估是回顾性进行的，也就是说，仅在每次人群调查完成之后。评估重点是据报告在每次调查中应用的质量保证和控制程序，以及从每次调查记录的血压值得出的质量指标。特定质量评估项目的定义基于莫尼卡项目方案和相关文献中的资料来源。关于质量保证和控制程序的现有信息仅依赖于当地调查组织者的自我报告和实地考察，并且偶尔发现与实际血压记录存在差异。因此，从实际血压记录得出的质量指标在各次调查之间更具信息性且更具可比性。就单个质量项目而言，每次调查被评为最佳、满意或不满意，这些单个分数共同用于计算每次调查的血压测量质量汇总分数。该汇总分数表明，47次莫尼卡基线调查中有39次显示出最佳或满意的血压测量质量。质量评估的局限性和改进潜力变得明显。我们得出结论，在流行病学人群调查中对血压测量质量进行标准化评估似乎是可行的，并建议类似于本文所建议的质量评估方法成为未来人群血压值和高血压流行病学分析的常规组成部分。这将有助于进行有效的研究比较。
