Personalizing Intervention to Reduce Clinical Inertia in the Treatment of Hypertension
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      This is a three-arm pragmatic randomized controlled trial to test two interventions targeting
      clinical inertia in hypertension compared to control, followed by predictive modeling to
      identify factors that are associated with intervention responsiveness. Study investigators
      will use EHR data to identify providers of patients whose hypertension treatment was not
      intensified. Primary care physicians will then be randomized to one of three arms: pharmacist
      e-detailing, provider dashboards, or no intervention (control). After the intervention, the
      investigators will conduct virtual interviews with select providers from each arm. A
      predictive modeling approach will then be used to identify patient and provider
      characteristics that are associated with inertia and with responsiveness to each
      intervention.
    

Detailed description: 
      We propose a pragmatic randomized controlled trial to test two interventions targeting
      clinical inertia in hypertension compared to control, followed by predictive modeling to
      identify factors that are associated with intervention responsiveness.

      For Aim 1, we will use Electronic Health Record (EHR) data to identify physicians of patients
      whose hypertension treatment was not intensified despite their having persistently elevated
      blood pressure. We will then randomize primary care physicians to on of three arms: academic
      e-detailing, social norming, or no intervention (control).

      For Aim 2, we will conduct interviews with select physicians from each arm. We will then
      identify patient and physician characteristics that are associated with inertia and with
      responsiveness to each intervention.
    

Intervention name(s): Audit and Feedback; Pharmacist E-Detailing
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A report of the provider's hypertension control rates compared to benchmark will be displayed using principles of social norming. We will present that provider's hypertension control rates compared to the 90th percentile of their peers.; A pharmacist will review the chart in advance and provide a personalized recommendation for how to intensify the specific patient's antihypertensive regimen based on current guidelines. For example, they might recommend adding an additional medication based on the patient's comorbid conditions and could suggest a starting dose and timeframe for dose escalation.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This was a cluster-randomized trial randomized at the provider level. Primary care providers were invited to participate and consented into the study. Patients accrued into the study were study-eligible patients cared for by each enrolled primary care provider. The number of participants listed below includes both patients and providers (466 patients and 45 providers).
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research