Hypertension Clinical Trial
Official title:
CERT-HIT: A Multimodal Intervention to Improve Antihypertensive and Lipid-lowering Therapy
The purpose of this study is to evaluate the impact of electronic health record clinical decision support and automated telephone outreach on antihypertensive and lipid-lowering therapy in ambulatory care.
The quality of care delivered in physicians' offices is suboptimal. Underuse of proven,
potentially life-saving medications, such as anti-hypertensive agents and statins for
lipid-lowering, is unfortunately no exception. Data from more than 70 million people
collected for the 2005 HEDIS Report Card show that fewer than half of those patients at high
risk for myocardial infarction have adequately controlled lipids and fewer than 70% of
patients with hypertension have blood pressure controlled; annually this suboptimal
treatment accounts for more than 10,000 avoidable deaths, $333 million in avoidable hospital
costs, 27.2 million sick days and $4.5 billion in lost productivity.
The "care-gaps" in the management of blood pressure and lipids arise from numerous barriers
to optimal practice at the level of the system, the provider, and the patient. Process
evaluations of quality improvement efforts have cited several barriers as the most
important: inadequate time, resources, and support; limitations in computer technology,
including insufficient information management; little use of formal change processes; too
many competing priorities; a lack of agreement about the desired changes; and inadequate
physician engagement.
Both computerized clinical decision support (CDS) in the context of a robust electronic
health record (EHR) and automated telephone outreach to patients with interactive voice
recognition (IVR) to patients are promising interventions to overcome the barriers that
physicians and patients encounter in treating hypertension and hyperlipidemia. While recent
studies have begun to demonstrate the effectiveness of CDS in the ambulatory setting, there
is an urgent need to implement and evaluate these systems in the practices of physicians
practicing solo or in small groups in the community, outside the extensive HIT
infrastructure of academic medical centers and integrated delivery systems.
IVR is a patient-outreach intervention that involves automated telephone calls to patients
to patients in a conversation about specific health-related issues. Randomized control
trials (RCTs) have shown that IVR monitoring with clinician follow-up can improve self-care,
perceived health status, and physiologic outcomes among individuals with diabetes and
hypertension.
The specific aim of this project is to evaluate, the effectiveness of CDS alone compared to
IVR to improve the use of antihypertensive and lipid-lowering medications in community-based
primary care practices.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Open Label, Primary Purpose: Treatment
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