Electronic Health Record-Based Clinical Decision Support to Improve Blood Pressure Management in Adolescents
Condition: Hypertension; Pre Hypertension; Obesity
MeSH terms: Hypertension; Prehypertension
Study type: Interventional

Summary: 
      The goal of this project is to improve detection and management of elevated blood pressure in
      adolescents. It (a) uses electronic health record (EHR) technology to deliver
      patient-specific clinical decision support (CDS) to providers at the point of care, (b)
      assesses the impact of this intervention on identification and clinical care of hypertension
      in adolescents, and (c) assesses the impact of the intervention on costs of care.
    

Detailed description: 
      Hypertension (HT) during adolescence tracks into adulthood, contributing to adult
      cardiovascular morbidity and mortality. National guidelines for the diagnosis and treatment
      of hypertension in children and adolescents were developed by the National High Blood
      Pressure Education Program (NHBPEP); their Fourth Report was published in 2004. Despite
      heightened awareness of hypertension in pediatric populations, most adolescents with elevated
      blood pressure remain clinically unrecognized. Factors that contribute to this gap in care
      include: the need to translate adolescent blood pressure (BP) measures into blood pressure
      percentiles on the basis of age, gender, and height, lack of familiarity with National High
      Blood Pressure Education Program (NHBPEP) clinical guidelines, and competing demands at
      clinical encounters.

      Electronic health record (EHR)-based clinical decision support (CDS) can be used to address
      these barriers and support better care of elevated blood pressure (BP) and Hypertension (HT)
      in adolescents. In this project, the investigators integrate EHR-extracted data with
      sophisticated Web-based CDS algorithms to provide patient-specific point-of-care clinical
      recommendations, in accordance with NHBPEP guidelines. To evaluate the impact of this
      innovation on quality and cost of care, the investigators randomize 18 clinics with their 130
      pediatric care providers (PCP) and their estimated 17,000 adolescent patients to receive or
      not receive this EHR-based CDS intervention. The investigators hypothesize that the
      intervention will improve recognition and early management of elevated BP and that short-term
      increases in outpatient care costs will be offset by longer-term clinical benefits, estimated
      using established econometric models.

      This innovative project (a) addresses the under-recognized high-risk patient population of
      adolescents, (b) integrates EHR and Web-based CDS technology to provide sophisticated
      patient-specific point-of-care CDS, (c) develops and implements novel and intuitive visual
      interfaces to communicate CDS recommendations to PCPs, and (d) provides both clinical and
      cost outcome data useful to clinicians and policymakers. If the EHR-based CDS intervention
      improves adherence to NHBPEP recommendations, it will provide a much-needed tool to combat
      the burgeoning problem of rising cardiovascular risk factors in children and adolescents.
      Further, regardless of outcome, the technology that is developed and tested will provide many
      useful insights to advance the science of EHR-based CDS. This will, in turn, help translate
      the massive public and private investments in EHR technology into improved adolescent health
      outcomes.
    

Intervention name(s): Clinical Decision Support (CDS)
Intervention type(s): Behavioral
Intervention description(s): The Clinical Decision Support (CDS) tool will be activated when a BP is entered in the vital sign section of the EHR. The CDS tool includes six key features: (i) prompts regarding the need for height data to classify the BP by percentile (ii) prompts to repeat any BP that is ≥90% or ≥120/80 mm Hg (iii) classification of BPs by percentile, including classification of those in pre-HT, stage 1 HT and stage 2 HT range (iv) review of previous HT diagnoses and BPs in order to classify elevated BPs as incident (first or second elevated BP) or persistent (third or greater elevated BP) (v) tailored CDS based on HT category and previous diagnoses (vi) graphical representation of current and historical BP data by age and BP percentile.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Adolescent Hypertension; Adolescent Pre Hypertension; Adolescent Pre Hypertension and Obesity