Clinical Decision Support for Recognition and Management of Hypertension: A Randomized Trial

Kharbanda, Elyse O.; Asche, Steve; Sinaiko, Alan R.; Ekström, Heidi; Sherwood, Nancy E.; Fontaine, Patricia; Dehmer, Steven P.; Appana, Deepika; O’Connor, Patrick J.

doi:10.1542/peds.2017-2954

Cited by 57 publications

(64 citation statements)

References 18 publications

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“…Yet ASD cannot be diagnosed in infants, and there is no clear predictor of ASD in infants. Given that ~20% (Ozonoff et al, 2011) and 30% (Charman et al, 2017) of younger siblings of children with ASD, respectively, will receive a diagnosis of ASD or meet criteria for other developmental disruptions by 36 months of age, a public health approach to detecting ASD risk and monitoring at-risk children is needed (e.g. pre-term infants; Darcy-Mahoney et al, 2016).…”

Section: When To Start Intervention?mentioning

confidence: 99%

Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders

Landa

2018

International Review of Psychiatry

272

158

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With advances in the field’s ability to identify autism spectrum disorders (ASD) at younger ages, the need for information about the evidence-base for early intervention continues to rise. This review of the ASD early intervention (EI) literature focuses on efficacy studies published within the past 15 years. The neurodevelopmental context for early intervention, timing of initiating intervention, primary intervention approaches, and predictors of treatment outcomes are discussed. The evidence indicates that young children with ASD benefit from EI, and their parents learn to implement child-responsive engagement strategies when a parent-coaching intervention is provided. Evidence supports combining parent-mediated and direct clinician-implemented intervention to maximize child developmental gains. Clinical practice recommendations are presented, based on the literature reviewed.

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Section: When To Start Intervention?mentioning

confidence: 99%

Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders

Landa

2018

International Review of Psychiatry

272

158

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“…Initiatives to improve recognition of HTN in the outpatient setting have included improved clinical decision support built into the EMR, and use of screening tables to provide more concise age‐ and sex‐based norms for pediatric BP, thus limiting the need to consult the more comprehensive tables that include height‐based thresholds. Both approaches have promise based on published studies, but even with the effective use of these tools, elevated BP remains commonly under‐recognized 20‐23 . In the inpatient setting, an EMR‐based intervention, especially one that calculates patient‐specific thresholds for appropriate BP based on admission height, age, and sex, could effectively warn staff of a BP elevation at the moment recognition is needed (when inputting a BP into the patient’s vitals record).…”

Section: Discussionmentioning

confidence: 99%

Identification of hypertension in hospitalized children prescribed as‐needed antihypertensive medication

Kocher¹,

Tumin

Lehmann

et al. 2020

J of Clinical Hypertension

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Imperfect measurement conditions, transient blood pressure (BP) elevation due to pain or anxiety, and heavy clinical demands complicate hypertension (HTN) diagnosis in hospitalized children, and may prevent recognition of hypertensive episodes for children prescribed as‐needed (PRN) antihypertensive medication. The authors sought to describe the incidence and predictors of missed BP elevation among hospitalized children prescribed PRN antihypertensive medication at our hospital. BP data were retrospectively audited for children age 2‐18 admitted in 2018 to the general ward, and prescribed PRN oral nifedipine, intravenous [IV] or oral hydralazine, or IV labetalol. Appropriate recognition of BP elevation (exceeding the parameters in the medication order) was defined as administering medication within the ordered dosing interval, administering the medication earlier than planned, or physician documentation of why HTN treatment was withheld. Mixed‐effects logistic regression was used to identify factors associated with recognition of BP elevation. Fifty‐six hospitalizations including 616 BP measurements were analyzed. BP elevation was appropriately recognized in 230 (37%) instances, in most of which (n = 190) the antihypertensive medication was given after excessive BP was noted. On multivariable analysis, higher systolic BP and BP elevation occurring at night were associated with increased likelihood of appropriate recognition. BP elevations are frequently missed in hospitalized children prescribed PRN antihypertensive medication. Particularly, there was low recognition of diastolic BP elevation and of systolic BP elevation close to but still exceeding the ordered threshold. Further staff education may be needed to raise awareness of lower BP thresholds for HTN in younger and smaller children.

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“…However, it is worth noting that in a series of randomized trials, Priorities Wizard has been shown to improve BP control, glucose control, smoking cessation, and cardiovascular risk, reduce clinical inertia, and improve recognition and diagnosis of diabetes in those who meet clinical criteria for the disease. [16][17][18][19][20] Moreover, a formal cost-effectiveness analysis shows a base-case estimate of $3017 per quality adjusted life year gained, and the CDS system is likely to be cost saving to payers at scale. 21 Should Diabetes CDS Stand Alone, or Be Integrated with CDS for Other Conditions?…”

Section: Priorities Wizard: a Current Diabetes Clinical Decision Suppmentioning

confidence: 99%

Current Status and Future Directions for Electronic Point-of-Care Clinical Decision Support to Improve Diabetes Management in Primary Care

O’Connor

Sperl-Hillen

2019

Diabetes Technology & Therapeutics

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In the past decade there have been major improvements in the design, use, and effectiveness of point-of-care clinical decision support (CDS) systems to improve quality of care for patients with diabetes and related conditions. Advances in data exchange, data security, and human factors research have driven these improvements. Current diabetes CDS systems have high use rates, high clinician/user satisfaction rates, and have measurably improved glucose control, blood pressure control, and cardiovascular risk trajectories in adults with diabetes. As diabetes care increasingly relies on complex biomarker-driven risk prediction methods to optimize care goals and prioritize treatment options based on potential benefit to an individual patient, CDS systems will become indispensable tools to guide clinician and patient decision-making. In this study we describe specific challenges that must be addressed further to improve the design, implementation, and effectiveness of primary care diabetes CDS systems in coming years.

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Clinical Decision Support for Recognition and Management of Hypertension: A Randomized Trial

Abstract: The CDS had a significant, beneficial effect on the recognition of hypertension, with a moderate increase in guideline-adherent management.

Cited by 57 publications

References 18 publications

Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders

Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders

Identification of hypertension in hospitalized children prescribed as‐needed antihypertensive medication

Current Status and Future Directions for Electronic Point-of-Care Clinical Decision Support to Improve Diabetes Management in Primary Care

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