Obesity Clinical Trial
Official title:
Electronic Health Record-Based Clinical Decision Support to Improve Blood Pressure Management in Adolescents
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.
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.
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