Clinical-Decision Support to Improve Hypertension Care in Primary Care
Condition: Hypertension; Blood Pressure; Overweight and Obesity
MeSH terms: Hypertension; Overweight
Study type: Interventional

Summary: 
      Approaches are needed to help primary-care pediatricians address high blood pressure. This
      study will test whether an electronic health-record-based tool to address high blood pressure
      is feasible and improves the evaluation and management of high blood pressure in clinical
      practice. If successful, this approach can be used to address other lifestyle-related and
      complex health problems (e.g., dyslipidemia and diabetes), then disseminated and used
      nationwide.

      The investigators have developed a new, electronic health-record (EHR)-based tool that is
      designed to help pediatricians:

        1. IDENTIFY AND DOCUMENT

             1. when a child's blood pressure is elevated, and

             2. whether it has been elevated before--including number of prior elevations to
                document the correct diagnosis (for example, elevated blood pressure, vs.
                hypertension stage 1, vs. hypertension stage 2), THEN

        2. ORDER the next action(s) needed per guideline-based recommendations, AND per prior
           actions taken--including:

             1. laboratories and studies per 2017 updated guidelines

             2. follow-up interval in primary care

             3. referral to nephrology, when indicated, and

             4. patient education on diet/lifestyle modification.

      The investigators are working on improving this system further with addition of orders for:

        1. referral for sleep-apnea testing and treatment, when indicated, and

        2. blood-pressure medications (for example, initiation, titration, or addition of agents
           depending on blood-pressure control, comorbid conditions [e.g., diabetes], and risk for
           pregnancy)
    

Detailed description: 
      The investigators' data suggest that (1) addressing obesity-related comorbidities (in
      combination with high BMI/overweight/obesity) and more frequent follow-up are associated with
      weight-status improvement in overweight (OW) children, (2) that parents rank checking for
      weight-related health problems as the #1 most important recommended weight-management
      clinical practice, but that (3) comorbidities are infrequently addressed. Thus, to improve
      weight status, interventions are needed to improve comorbidity identification, evaluation,
      and management in primary care. Because the investigators' data suggest that identification
      of high blood pressure is particularly poor, and that identifying blood-pressure elevations
      in young children at three separate encounters is complex, they are using existing
      underutilized data to automate addressing high blood pressure/hypertension in an electronic
      health record system (EPIC-based), and, if successful, applying the method to other
      obesity-related comorbidities in primary care.

      OF NOTE: in developing and pilot-testing this decision support tool, providers wanted access
      to it for patients without overweight/obesity. Thus, although the trial was borne out of work
      in weight-management research, the initial trial will focus on all children irrespective of
      weight status.
    

Intervention name(s): clinical decision support
Intervention type(s): Other
Intervention description(s): Decision support system (see description of hypertension decision support system alerts and order sets for details)
Intervention model: Single Group Assignment
Intervention model description: Four-month time series trial
Masking: None (Open Label)
Primary purpose: Screening