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)
研究概览
详细说明
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.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Texas
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Dallas、Texas、美国、75390
- University of Texas Southwestern Medical Center, Parkland Medical Center, and (pilot took place at Children's Health)
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
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
学习计划
研究是如何设计的？
设计细节
- 主要用途：放映
- 分配：不适用
- 介入模型：单组作业
- 屏蔽：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的：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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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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High blood pressure addressed
大体时间：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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合作者和调查者
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.
clinical decision support的临床试验
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Beth Israel Deaconess Medical CenterBrigham and Women's Hospital; Clinical Innovations, LLC终止
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Medical University of South CarolinaNational Institutes of Health (NIH)招聘中
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Medical University of South CarolinaNational Center for Advancing Translational Sciences (NCATS)完全的
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UConn HealthUniversity of Texas at Austin; Oregon Social Learning Center主动，不招人
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Royal Brompton & Harefield NHS Foundation TrustMedical Research Council; The Hillingdon Hospitals NHS Foundation Trust终止
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University of Alabama at BirminghamNational Cancer Institute (NCI)主动，不招人
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Jaeb Center for Health ResearchJDRF Artificial Pancreas Project完全的