Clinical-Decision Support to Improve Hypertension Care in Primary Care
Automated Clinical-Decision Support to Improve Hypertension Care Among Overweight Children in Primary Care
Approaches are needed to help primary-care pediatricians address high blood pressure. This study will test whether an electronic health-record-based tool to address high blood pressure is feasible and improves the evaluation and management of high blood pressure in clinical practice. If successful, this approach can be used to address other lifestyle-related and complex health problems (e.g., dyslipidemia and diabetes), then disseminated and used nationwide.
The investigators have developed a new, electronic health-record (EHR)-based tool that is designed to help pediatricians:
IDENTIFY AND DOCUMENT
- when a child's blood pressure is elevated, and
- whether it has been elevated before--including number of prior elevations to document the correct diagnosis (for example, elevated blood pressure, vs. hypertension stage 1, vs. hypertension stage 2), THEN
ORDER the next action(s) needed per guideline-based recommendations, AND per prior actions taken--including:
- laboratories and studies per 2017 updated guidelines
- follow-up interval in primary care
- referral to nephrology, when indicated, and
- patient education on diet/lifestyle modification.
The investigators are working on improving this system further with addition of orders for:
- referral for sleep-apnea testing and treatment, when indicated, and
- blood-pressure medications (for example, initiation, titration, or addition of agents depending on blood-pressure control, comorbid conditions [e.g., diabetes], and risk for pregnancy)
調査の概要
詳細な説明
The investigators' data suggest that (1) addressing obesity-related comorbidities (in combination with high BMI/overweight/obesity) and more frequent follow-up are associated with weight-status improvement in overweight (OW) children, (2) that parents rank checking for weight-related health problems as the #1 most important recommended weight-management clinical practice, but that (3) comorbidities are infrequently addressed. Thus, to improve weight status, interventions are needed to improve comorbidity identification, evaluation, and management in primary care. Because the investigators' data suggest that identification of high blood pressure is particularly poor, and that identifying blood-pressure elevations in young children at three separate encounters is complex, they are using existing underutilized data to automate addressing high blood pressure/hypertension in an electronic health record system (EPIC-based), and, if successful, applying the method to other obesity-related comorbidities in primary care.
OF NOTE: in developing and pilot-testing this decision support tool, providers wanted access to it for patients without overweight/obesity. Thus, although the trial was borne out of work in weight-management research, the initial trial will focus on all children irrespective of weight status.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Texas
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Dallas、Texas、アメリカ、75390
- University of Texas Southwestern Medical Center, Parkland Medical Center, and (pilot took place at Children's Health)
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria for Providers: Pediatric primary care providers practicing at participating clinics that have agreed to have the decision-support system implemented.
Exclusion Criteria for Providers:
- Lack of electronic health record
Inclusion Criteria for Children:
- Measured systolic or diastolic blood pressure >=90th % for age/sex, or
- >=120 mmHg systolic or >=80 mmHg diastolic (whichever is lower)
Exclusion Criteria for Children:
- Diagnosis/visit for high blood pressure or hypertension in past 2 years
- Taking anti-hypertensive medication
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：ふるい分け
- 割り当て：なし
- 介入モデル：単一グループの割り当て
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的：clinical decision support activated
TWO MED ASSIST ALERTS
ONE PROVIDER ALERT
TAILORED ORDERSETS
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Decision support system (see description of hypertension decision support system alerts and order sets for details)
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
High blood pressure addressed
時間枠：4-month time series analysis
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Proportion of patients with high blood pressure addressed post decision-support implementation (vs.
pre-), defined as proportion of patients with elevated blood pressures or higher who have one or more diagnosis or orders placed to diagnose, evaluate, or manage hypertension.
We will compare the slope of the post- vs. pre-implementation periods to examine change in monthly rate of HTN eval/management (indicated elements ordered/patients eligible) related to decision support that are in excess of secular trends in clinical practice.
In the post-implementation period, the denominator will be determined by tracking patient-level decision-support fires.
In the pre-implementation period, the denominator will be determined by applying the decision-support algorithm to retrospective data in monthly increments to identify patients who would have been eligible.
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4-month time series analysis
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協力者と研究者
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
clinical decision supportの臨床試験
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University of Wisconsin, MadisonAgency for Healthcare Research and Quality (AHRQ)募集
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Columbia UniversityNational Institute of Nursing Research (NINR); Brigham and Women's Hospital完了
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Wuerzburg University HospitalCharite University, Berlin, Germany; Goethe University; RWTH Aachen University; Technical University... と他の協力者募集
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Madigan Army Medical CenterTelemedicine & Advanced Technology Research Center; Analytics4Medicine, Inc.わからない
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Clinical Tools, Inc.National Institute on Alcohol Abuse and Alcoholism (NIAAA)完了うつ | アルコール;有害な使用 | 生活の質 | 燃え尽き症候群、プロフェッショナル | 燃え尽き症候群、学生 | 薬物使用 | 回復力アメリカ
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Medical University of South CarolinaNational Center for Advancing Translational Sciences (NCATS)完了
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Beth Israel Deaconess Medical CenterBrigham and Women's Hospital; Clinical Innovations, LLC募集
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UConn HealthUniversity of Texas at Austin; Oregon Social Learning Center招待による登録
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University of HawaiiNational Institute on Minority Health and Health Disparities (NIMHD)完了
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University of Alabama at BirminghamNational Cancer Institute (NCI)募集