Use of performance measures in combination with other quality improvement strategies at patient-, provider-, and system- based levels is reasonable to facilitate optimal hypertension control.S12.4.1-1 S12.4.1-3 Synopsis Efforts to improve suboptimal medical care include the use of performance measures, which are defined as standardized, vali- dated approaches to assess whether correct healthcare processes are being performed and that desired patient outcomes are being Performance measures are often combined with other quality improvement strategies, such as certification or financial incentives tied to higher-quality care.S12.4.1-5 Guidelines help define clinical care standards that can be used to develop per- formance measures.As guidelines evolve over time to incorporate new evidence, related performance measures may also evolve. Because identification, treatment, and control of hyperten- sion are suboptimal, performance measures for hypertension control have been developed and recommended for use in qual- ity improvement projects aimed at improving hypertension control and related outcomes in clinical practice.S12.4.1-6 S12.4.1-8 Because the specific methods used in performance measures can have an impact on their accuracy and ultimate impact (eg, the method of BP measurement used in the assessment), they should be developed, tested, and implemented according to See Online Data Supplement J for publicly available performance measures to assess the quality of hypertension care (generally using JNC 7 criteria). Recommendation-Specific Supportive Text 1. RCTs on the impact of performance measures on hyper- tension control are lacking; RCTs of quality improve- ment protocols have shown improvements in hypertension Furthermore, a large observational study showed that a systematic approach to hypertension control, including the use of performance measures, was associated with significant improvement in hypertension control compared with historical control groups.S12.4.1-3 12.4.2. Quality Improvement Strategies Recommendation for Quality Improvement Strategies References that support the recommendation are summarized in Online Data Supplements 66 and 67. COR LOE Recommendation IIa B-R 1. 