EHR-Based Clinical Decision Support to Improve BP Management in Adolescents



Status:Recruiting
Conditions:High Blood Pressure (Hypertension), Obesity Weight Loss
Therapuetic Areas:Cardiology / Vascular Diseases, Endocrinology
Healthy:No
Age Range:10 - 17
Updated:4/21/2016
Start Date:April 2014
End Date:August 2017
Contact:Elyse O Kharbanda, MD
Email:elyse.o.kharbanda@healthpartners.com
Phone:952-967-5038

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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 BP
percentiles on the basis of age, gender, and height, lack of familiarity with 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 BP and 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.

Inclusion Criteria:

- Adolescents age 10-17

- Pediatric and Family Medicine Providers

Exclusion Criteria:

- Pregnant adolescents

- Within 12 weeks post partum
We found this trial at
1
site
Minneapolis, Minnesota 55440
Principal Investigator: Elyse O Kharbanda, MD
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mi
from
Minneapolis, MN
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