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Clinical-Decision Support to Improve Hypertension Care in Primary Care

15 maj 2020 uppdaterad av: University of Texas Southwestern Medical Center

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:

  1. IDENTIFY AND DOCUMENT

    1. when a child's blood pressure is elevated, and
    2. 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

  2. ORDER the next action(s) needed per guideline-based recommendations, AND per prior actions taken--including:

    1. laboratories and studies per 2017 updated guidelines
    2. follow-up interval in primary care
    3. referral to nephrology, when indicated, and
    4. patient education on diet/lifestyle modification.

The investigators are working on improving this system further with addition of orders for:

  1. referral for sleep-apnea testing and treatment, when indicated, and
  2. 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)

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

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.

Studietyp

Interventionell

Inskrivning (Faktisk)

2803

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Förenta staterna
    • Texas
      • Dallas, Texas, Förenta staterna, 75390
        • University of Texas Southwestern Medical Center, Parkland Medical Center, and (pilot took place at Children's Health)

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

3 år till 18 år (Barn, Vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

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

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Undersökning
  • Tilldelning: N/A
  • Interventionsmodell: Enskild gruppuppgift
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: clinical decision support activated

TWO MED ASSIST ALERTS

  1. Enter height (when missing)
  2. Repeat BP (when high)

ONE PROVIDER ALERT

  1. BP high & prior BP/BP%s
  2. Defines elev. BP, HTN stage 1-2 with button to enter diagnosis
  3. Link to tailored ordersets

TAILORED ORDERSETS

  1. Elevated BP

    1. Button to schedule f-up <6 m
    2. Button for diet/lifestyle counseling/check-out instructions

  2. HTN stage 1

    1. Buttons to order labs/studies pre-checked for stage 1 recs
    2. Button for nephrology referral
    3. Button to schedule f-up in 1-2 wk/<1 m
    4. Button for diet/lifestyle counseling/check-out instructions

  3. HTN stage 2

    1. Buttons to order labs/studies for stage 2
    2. Button for nephrology referral (pre-checked)
    3. Button to f-up 1 wk
    4. Button for diet/lifestyle counseling/check-out instruction
Övrig: clinical decision support
Decision support system (see description of hypertension decision support system alerts and order sets for details)

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
High blood pressure addressed
Tidsram: 4-month time series analysis
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.
4-month time series analysis

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University of Texas Southwestern Medical Center

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

19 juli 2017

Primärt slutförande (Faktisk)

20 november 2017

Avslutad studie (Faktisk)

20 november 2017

Studieregistreringsdatum

Först inskickad

12 januari 2018

Först inskickad som uppfyllde QC-kriterierna

13 januari 2018

Första postat (Faktisk)

19 januari 2018

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

19 maj 2020

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

15 maj 2020

Senast verifierad

1 maj 2020

Mer information

Termer relaterade till denna studie

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • STU 052015-029

Plan för individuella deltagardata (IPD)

Planerar du att dela individuella deltagardata (IPD)?

NEJ

IPD-planbeskrivning

Data are being obtained under a MU agreement/legal contract

Läkemedels- och apparatinformation, studiedokument

Studerar en amerikansk FDA-reglerad läkemedelsprodukt

Nej

Studerar en amerikansk FDA-reglerad produktprodukt

Nej

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .

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