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Cited by 24Electronic Health Records SystemsBlood Pressure and Hypertension StudiesClinical practice guidelines implementation

Evaluation of an electronic clinical decision support tool for incident elevated BP in adolescents

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Kharbanda, Elyse Olshen, Asche, Stephen E., Sinaiko, Alan, Nordin, James D., Ekstrom, Heidi L., Fontaine, Patricia, Dehmer, Steven P., Sherwood, Nancy E. +1 more·2018·Academic Pediatrics
DOI 10.1016/j.acap.2017.07.004PMC PMC5756693
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Abstract

Objective To evaluate, among adolescents 10 to 17 years of age with an incident hypertensive blood pressure (BP; ≥95th percentile) at a primary care visit, whether TeenBP, a novel electronic health record-linked clinical decision support tool (CDS), improved recognition of elevated BP, and return for follow-up BP evaluation.Methods We conducted a pragmatic cluster randomized trial in 20 primary care clinics in a large Midwestern medical group. Ten clinics received the TeenBP CDS, including an alert to remeasure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1 to 3 weeks, and patient-specific order sets. In the 10 usual care (UC) clinics, elevated BPs were displayed in red font in the electronic health record. For comparisons between CDS and UC we used generalized linear mixed models.Results The study population included 607 CDS patients and 607 UC patients with an incident hypertensive BP. In adjusted analyses, at the index visit, CDS patients were more likely to have their hypertensive BP on the basis of ≥2 BP measurements (47.1% vs 27.6%; P = .007) and to have elevated BP (International Classification of Diseases, Ninth Revision code 796.2) diagnosed (28.2% vs 4.2%; P < .001). In a multivariate model adjusted for age, sex, systolic BP percentile, and visit type, rates for repeat BP measurement within 30 days were 14.3% at TeenBP CDS clinics versus 10.6% at UC clinics (P = .07).Conclusions The TeenBP CDS intervention significantly increased repeat BP measurement at the index visit and recognition of a hypertensive BP. Rates for follow-up BP measurement at 30 days were low and did not differ between TeenBP and UC subjects.

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Authors
Kharbanda, E. O., Asche, S. E., Sinaiko, A., Nordin, J. D., Ekstrom, H. L., Fontaine, P., Dehmer, S. P., Sherwood, N. E., & O'Connor, P. J.
Affiliations
  • HealthPartners (US)
  • University of Minnesota (US)
Corresponding author
Kharbanda, Elyse Olshen
ORCID
Venue
Academic Pediatrics
Publisher
Elsevier BV
Published
2018-01
Volume
18
Issue
1
Pages
43-50
ISSN
1876-2859 (ISSN-L)
DOI
10.1016/j.acap.2017.07.004
PMC
PMC5756693
OpenAlex
W2735138580
Cited by
24
References
22
Citations by year
2026: 2 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 2
FWCI
3.00
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Academic Pediatrics (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Health (R01 HL115082)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
clinical decision support, adolescent hypertension, elevated blood pressure, electronic health records, primary care, follow-up care, hypertension diagnosis, order sets
MeSH terms
Adolescent, Aftercare, Blood Pressure, Blood Pressure Determination, Child, Female, Humans, Hypertension, Male, Primary Health Care, Multivariate Analysis, Linear Models, Decision Support Systems, Clinical, Electronic Health Records

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