Record all readings accurately: Monitors with built-in memory should be brought to all clinic appointments. BP should be based on an average of readings on 2 occasions for clinical decision making. Clinical Recommendation 2017 Hypertension Clinical Practice Guidelines4 Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) ACC indicates American College of Cardiology; AHA, American Heart Association; BP, blood pressure; HBP, high blood pressure; HBPM, home blood pressure monitoring; and QCDR, Qualified Clinical Data Registry. 32 Appendix A. Continued Structural Quality Measures The Structural Quality Measure domain should be considered to be at the CDU level (can be a physician group practice, accountable care organization, clinically integrated network, health plan, or integrated delivery system), as opposed to the specific patient or physician/clinician level. The goal will be to guide and motivate CDUs to implement and evaluate these specific guideline recommendations to improve the various and necessary evidence-based components of a guideline-driven system of care and accompanying infrastructure needed for effective identification and management of patients with HBP. Diagnosis, Assessment, and Accurate Measurement SM-1: Use of a Standard Protocol to Consistently and Correctly Measure BP in the Ambulatory Setting Measure Components The CDU uses a standard process/protocol for properly measuring BP consistently and correctly, including: Adoption and implementation of a protocol for accurate measurement and documentation of BP. Availability of staff who are trained in measurement and documentation of BP. Documentation of staff assessment of correct BP measurement skill. Elements Protocol includes preassessment tools, checklists, and metrics to assess gaps in care. Certification of staff in correct BP measurement skills. 