Office-Based Interventions for Recognizing Abnormal Pediatric Blood Pressures

McLaughlin, Douglas; Hayes, John R.; Kelleher, Kelly J.

doi:10.1177/0009922809339844

Cited by 8 publications

(6 citation statements)

References 30 publications

(34 reference statements)

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“…20–22 Similar studies in pediatrics have been limited. 23, 24 An intervention performed in primary care pediatric practices using either simplified BP tables attached to the medical chart or using a PDA tool to calculate BP percentiles was not associated with significant improvement in recognition, and uptake of the intervention tool was fairly low. 23 Another smaller, EHR based intervention study found that automated reminders did improve in abnormal BP recognition.…”

Section: Discussionmentioning

confidence: 98%

“…23, 24 An intervention performed in primary care pediatric practices using either simplified BP tables attached to the medical chart or using a PDA tool to calculate BP percentiles was not associated with significant improvement in recognition, and uptake of the intervention tool was fairly low. 23 Another smaller, EHR based intervention study found that automated reminders did improve in abnormal BP recognition. 24 While use of the SMART BP app was associated with significant improvement in recognition of elevated blood pressures, uptake proved similarly challenging.…”

Section: Discussionmentioning

confidence: 98%

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The effect of an electronic health record-based tool on abnormal pediatric blood pressure recognition

Twichell

Rea

Melvin

et al. 2017

Congenital Heart Disease

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Background Recognition of high blood pressure (BP) in children is poor, partly due to the need to compute age-sex-height referenced percentiles. This study examined the change in abnormal BP recognition before versus after the introduction of an electronic health record (EHR) app designed to calculate BP percentiles with a training lecture. Methods and Results Clinical data were extracted on all ambulatory, non-urgent encounters for children 3–18 years old seen in primary care, endocrinology, cardiology, or nephrology clinics at an urban, academic hospital in the year before and the year after app introduction. Outpatients with at least 1 BP above the age-gender-height referenced 90th percentile were included. Abnormal BP recognition was defined as a BP related ICD-9 code, referral to nephrology or cardiology, an echocardiogram or renal ultrasound to evaluate BP concern, or a follow-up primary care visit for BP monitoring. Multivariable adjusted logistic regression compared odds of recognition before and after app introduction. Of 78,768 clinical encounters, 3,521 had abnormal BP in the pre and 3,358 in the post-app period. App use occurred in 13% of elevated BP visits. Overall, abnormal BP was recognized in 4.9% pre-app period visits and 7.1% of visits post-app (p<0.0001). Recognition was significantly higher when the app was actually used (adjusted OR 3.17 95% CI 2.29–4.41, p<0.001). Without app use recognition was not different. Conclusions BP app advent modestly increased abnormal BP recognition in the entire cohort, but actual app use was associated with significantly higher recognition. Predictors of abnormal BP recognition deserve further scrutiny.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

The effect of an electronic health record-based tool on abnormal pediatric blood pressure recognition

Twichell

Rea

Melvin

et al. 2017

Congenital Heart Disease

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“…4 These results are similar to those obtained in a pediatric emergency department setting 5 and in a large pediatric primary care setting. 6,7 …”

Section: Introductionmentioning

confidence: 99%

Real-Time Electronic Medical Record Alerts Increase High Blood Pressure Recognition in Children

Brady

Neu

Miller

et al. 2014

Clin Pediatr (Phila)

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Objective Pediatric hypertension remains largely unrecognized. We hypothesized that an electronic medical record (EMR) alert would increase elevated blood pressure (BP) recognition in a pediatric primary care setting. Study Design Pre–post evaluation of a real-time EMR alert and one-time provider educational session. A total of 1305 encounters of children 3 to 21 years with elevated intake BP and no prior hypertension diagnosis were included. Elevated BP recognition and relationship of recognition with cardiovascular disease (CVD) risk factors during the intervention was compared with an historical control. Results Recognition increased from 12.5% to 42% (P < .001). Recognition increased soon after alert implementation and was sustained without evidence of “alert fatigue.” During both periods, presence of CVD risk factors was associated with recognition. However, the magnitude was lesser in the intervention period. Conclusions Real-time EMR alerts substantially increase elevated BP recognition in children. However, underrecognition of elevated BP persisted, highlighting the need for additional strategies to improve provider recognition.

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“…Following screening by two independent Community Guide reviewers, a total of 57 articles 24–80 representing 50 unique studies of CDSSs for CVD prevention were identified. Of these, 46 studies 24–68,80 met inclusion criteria; however, seven studies 35,40,49,57,59,62,64 judged to be of limited quality of execution were excluded from analysis. The update search (January 2011 through October 2012) identified 14 articles representing 13 unique studies.…”

Section: Evidence Synthesismentioning

confidence: 99%

Clinical Decision Support Systems and Prevention

Njie

Proia

Thota

et al. 2015

American Journal of Preventive Medicine

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Context Clinical decision support systems (CDSSs) can help clinicians assess cardiovascular disease (CVD) risk and manage CVD risk factors by providing tailored assessments and treatment recommendations based on individual patient data. The goal of this systematic review was to examine the effectiveness of CDSSs in improving screening for CVD risk factors, practices for CVD-related preventive care services such as clinical tests and prescribed treatments, and management of CVD risk factors. Evidence acquisition An existing systematic review (search period, January 1975–January 2011) of CDSSs for any condition was initially identified. Studies of CDSSs that focused on CVD prevention in that review were combined with studies identified through an updated search (January 2011–October 2012). Data analysis was conducted in 2013. Evidence synthesis A total of 45 studies qualified for inclusion in the review. Improvements were seen for recommended screening and other preventive care services completed by clinicians, recommended clinical tests completed by clinicians, and recommended treatments prescribed by clinicians (median increases of 3.8, 4.0, and 2.0 percentage points, respectively). Results were inconsistent for changes in CVD risk factors such as systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol, and hemoglobin A1C levels. Conclusions CDSSs are effective in improving clinician practices related to screening and other preventive care services, clinical tests, and treatments. However, more evidence is needed from implementation of CDSSs within the broad context of comprehensive service delivery aimed at reducing CVD risk and CVD-related morbidity and mortality.

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Office-Based Interventions for Recognizing Abnormal Pediatric Blood Pressures

Cited by 8 publications

References 30 publications

The effect of an electronic health record-based tool on abnormal pediatric blood pressure recognition

The effect of an electronic health record-based tool on abnormal pediatric blood pressure recognition

Real-Time Electronic Medical Record Alerts Increase High Blood Pressure Recognition in Children

Clinical Decision Support Systems and Prevention

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