FROM PEDIATRICS
Hypertension discovery in pediatric patients more than doubled for physicians using a clinical decision support (CDS) tool connected to the EHR, results of a study found.
Elyse O. Kharbanda, MD, MPH, a researcher at the HealthPartners Institute, Minneapolis, and her fellow investigators assert that using such a tool will help rectify the trend of underreported hypertension in adolescents, which remains a serious concern despite providers’ routinely taking blood pressure measurements during outpatient visits.
The new tool, TeenBP, collects and interprets records from a patient’s EHR to notify physicians when blood pressure readings reach a concerning level, alleviating the pressures of time and navigating the EHR that can be barriers to uncovering hypertension, according to Dr. Kharbanda and her coinvestigators, who developed the tool.
“Among patients with multiple visits, electronic health records should contain sufficient information to diagnose hypertension,” Dr. Kharbanda and her associates reported in their article published in Pediatrics. “However, even when EHRs are configured to display BP percentiles, information on the patterns of BP percentiles over time, previous diagnoses, and medications is not presented in a format that is useful for clinicians.”
With TeenBP, providers are first prompted to take an initial BP reading, as well as height and weight measurements.
If the first measure is above the 95th percentile, the CDS requests an additional reading, which is then averaged with the first. If average of the two is above or within the 95th percentile, the provider is notified and sent a list of recommendations, including a diagnosis of hypertension, lipid screening, and nutrition referral.
The 2-year trial included 522 pediatric patients with incident hypertension; the data were gathered from 20 primary care clinics within one health system between April 2014 and April 2016.
Investigators split the children into two arms: 296 were seen in clinics using the TeenBP CDS, and the other 226 were seen in clinics employing usual care procedures. Patients were an average of 14.5 years old, and the majority were white.
The rate of clinical recognition of patients’ hypertension in the clinics utilizing the CDS tool was more than double the rate seen in the clinics that weren’t (55% and 21%, respectively; P less than .001).
More of the children seen in CDS clinics were referred to dietitians or weight loss programs, compared with those seen in the control clinics (17% and 4%, respectively; P = .001).
Those who used the tool reported high levels of satisfaction, which is likely partly because investigators consulted physicians to help design the application.
“The CDS tool was based on the guidelines for BP management in children and adolescents in effect at the time of the study with local input from clinical and operational leaders within the medical group, and thus it contained the so-called right information,” according to Dr. Kharbanda and her fellow investigators.
Of the 55 physicians who remembered using the tool, 92% thought is was useful in identifying hypertension, 94% considered the CDS a good use of time, and 95% believed is was a useful shared-decision making tool.
When designing TeenBP, investigators tailored the application to the work flow and culture of the health system used for the study, which may limit the generalizability of the findings.
The study was funded by the National Institutes of Health. Dr. Kharbanda and her associates reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
Source: Kharbanda EO et al. Pediatrics. 2018. doi: 10.1542/peds.2017- 2954 .
