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Hypertension discovery in pediatric patients more than doubled for physicians using a clinical decision support (CDS) tool connected to the EHR, results of a study found.
Elyse O. Kharbanda, MD, MPH, a researcher at the HealthPartners Institute, Minneapolis, and her fellow investigators assert that using such a tool will help rectify the trend of underreported hypertension in adolescents, which remains a serious concern despite providers’ routinely taking blood pressure measurements during outpatient visits.
“Among patients with multiple visits, electronic health records should contain sufficient information to diagnose hypertension,” Dr. Kharbanda and her associates reported in their article published in Pediatrics. “However, even when EHRs are configured to display BP percentiles, information on the patterns of BP percentiles over time, previous diagnoses, and medications is not presented in a format that is useful for clinicians.”
With TeenBP, providers are first prompted to take an initial BP reading, as well as height and weight measurements.
If the first measure is above the 95th percentile, the CDS requests an additional reading, which is then averaged with the first. If average of the two is above or within the 95th percentile, the provider is notified and sent a list of recommendations, including a diagnosis of hypertension, lipid screening, and nutrition referral.
The 2-year trial included 522 pediatric patients with incident hypertension; the data were gathered from 20 primary care clinics within one health system between April 2014 and April 2016.
The rate of clinical recognition of patients’ hypertension in the clinics utilizing the CDS tool was more than double the rate seen in the clinics that weren’t (55% and 21%, respectively; P less than .001).
More of the children seen in CDS clinics were referred to dietitians or weight loss programs, compared with those seen in the control clinics (17% and 4%, respectively; P = .001).
Those who used the tool reported high levels of satisfaction, which is likely partly because investigators consulted physicians to help design the application.
“The CDS tool was based on the guidelines for BP management in children and adolescents in effect at the time of the study with local input from clinical and operational leaders within the medical group, and thus it contained the so-called right information,” according to Dr. Kharbanda and her fellow investigators.
Of the 55 physicians who remembered using the tool, 92% thought is was useful in identifying hypertension, 94% considered the CDS a good use of time, and 95% believed is was a useful shared-decision making tool.
When designing TeenBP, investigators tailored the application to the work flow and culture of the health system used for the study, which may limit the generalizability of the findings.
The study was funded by the National Institutes of Health. Dr. Kharbanda and her associates reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
Source: Kharbanda EO et al. Pediatrics. 2018. doi: 10.1542/peds.2017- 2954.
The rate of children and adolescents with elevated blood pressure going unrecognized is an increasingly concerning issue – one that is complicated because physicians lack a simple, single BP value system. Some have tried to fill the gap, creating simplified tables of BP values or automated displays of BP values in EHRs, but having a table that only takes age and sex into consideration for screening does not cover the complexities needed to identify hypertension.
Previous studies have looked into utilizing a clinical decision support (CDS) application, which has great potential as a digital multitool to improve quality of care, increase efficiency, and reduce medical errors. However, to be an effective CDS, it must fill the “CDS Five Rights” framework. This guideline states that a CDS tool needs to provide: “the right information, to the right people, through the right channels, in the right intervention formats, at the right points in the work flow.”
The TeenBP CDS developed by Kharbanda et al. fulfills these requirements and goes beyond any CDS previously designed. Even so, 45% of children with elevated BP or hypertension were not recognized, emphasizing the need for additional strategies outside of relying on new technology.
Visit summaries should be given to parents with BP readings so that they can monitor their children’s levels, for example.
Recognition of abnormal BP in teens is the first step toward preventing cardiovascular disease as an adult, and hopefully, the development of new tools, including this CDS, will help physicians find those children who have been overlooked.
Ari H. Pollack, MD, MSIM, is a pediatric nephrologist at the Seattle Children’s Hospital and an assistant professor of pediatrics at the University of Washington, Seattle. Joseph T. Flynn, MD, MS, is the division chief of nephrology in prenatal diagnosis and treatment at the Seattle Children’s Hospital and a professor of pediatrics at the same university. Dr. Pollack and Dr. Flynn reported no relevant financial disclosures in their commentary in Pediatrics (2018. doi: 10.1542/peds.2017-3756).
The rate of children and adolescents with elevated blood pressure going unrecognized is an increasingly concerning issue – one that is complicated because physicians lack a simple, single BP value system. Some have tried to fill the gap, creating simplified tables of BP values or automated displays of BP values in EHRs, but having a table that only takes age and sex into consideration for screening does not cover the complexities needed to identify hypertension.
Previous studies have looked into utilizing a clinical decision support (CDS) application, which has great potential as a digital multitool to improve quality of care, increase efficiency, and reduce medical errors. However, to be an effective CDS, it must fill the “CDS Five Rights” framework. This guideline states that a CDS tool needs to provide: “the right information, to the right people, through the right channels, in the right intervention formats, at the right points in the work flow.”
The TeenBP CDS developed by Kharbanda et al. fulfills these requirements and goes beyond any CDS previously designed. Even so, 45% of children with elevated BP or hypertension were not recognized, emphasizing the need for additional strategies outside of relying on new technology.
Visit summaries should be given to parents with BP readings so that they can monitor their children’s levels, for example.
Recognition of abnormal BP in teens is the first step toward preventing cardiovascular disease as an adult, and hopefully, the development of new tools, including this CDS, will help physicians find those children who have been overlooked.
Ari H. Pollack, MD, MSIM, is a pediatric nephrologist at the Seattle Children’s Hospital and an assistant professor of pediatrics at the University of Washington, Seattle. Joseph T. Flynn, MD, MS, is the division chief of nephrology in prenatal diagnosis and treatment at the Seattle Children’s Hospital and a professor of pediatrics at the same university. Dr. Pollack and Dr. Flynn reported no relevant financial disclosures in their commentary in Pediatrics (2018. doi: 10.1542/peds.2017-3756).
The rate of children and adolescents with elevated blood pressure going unrecognized is an increasingly concerning issue – one that is complicated because physicians lack a simple, single BP value system. Some have tried to fill the gap, creating simplified tables of BP values or automated displays of BP values in EHRs, but having a table that only takes age and sex into consideration for screening does not cover the complexities needed to identify hypertension.
Previous studies have looked into utilizing a clinical decision support (CDS) application, which has great potential as a digital multitool to improve quality of care, increase efficiency, and reduce medical errors. However, to be an effective CDS, it must fill the “CDS Five Rights” framework. This guideline states that a CDS tool needs to provide: “the right information, to the right people, through the right channels, in the right intervention formats, at the right points in the work flow.”
The TeenBP CDS developed by Kharbanda et al. fulfills these requirements and goes beyond any CDS previously designed. Even so, 45% of children with elevated BP or hypertension were not recognized, emphasizing the need for additional strategies outside of relying on new technology.
Visit summaries should be given to parents with BP readings so that they can monitor their children’s levels, for example.
Recognition of abnormal BP in teens is the first step toward preventing cardiovascular disease as an adult, and hopefully, the development of new tools, including this CDS, will help physicians find those children who have been overlooked.
Ari H. Pollack, MD, MSIM, is a pediatric nephrologist at the Seattle Children’s Hospital and an assistant professor of pediatrics at the University of Washington, Seattle. Joseph T. Flynn, MD, MS, is the division chief of nephrology in prenatal diagnosis and treatment at the Seattle Children’s Hospital and a professor of pediatrics at the same university. Dr. Pollack and Dr. Flynn reported no relevant financial disclosures in their commentary in Pediatrics (2018. doi: 10.1542/peds.2017-3756).
Hypertension discovery in pediatric patients more than doubled for physicians using a clinical decision support (CDS) tool connected to the EHR, results of a study found.
Elyse O. Kharbanda, MD, MPH, a researcher at the HealthPartners Institute, Minneapolis, and her fellow investigators assert that using such a tool will help rectify the trend of underreported hypertension in adolescents, which remains a serious concern despite providers’ routinely taking blood pressure measurements during outpatient visits.
“Among patients with multiple visits, electronic health records should contain sufficient information to diagnose hypertension,” Dr. Kharbanda and her associates reported in their article published in Pediatrics. “However, even when EHRs are configured to display BP percentiles, information on the patterns of BP percentiles over time, previous diagnoses, and medications is not presented in a format that is useful for clinicians.”
With TeenBP, providers are first prompted to take an initial BP reading, as well as height and weight measurements.
If the first measure is above the 95th percentile, the CDS requests an additional reading, which is then averaged with the first. If average of the two is above or within the 95th percentile, the provider is notified and sent a list of recommendations, including a diagnosis of hypertension, lipid screening, and nutrition referral.
The 2-year trial included 522 pediatric patients with incident hypertension; the data were gathered from 20 primary care clinics within one health system between April 2014 and April 2016.
The rate of clinical recognition of patients’ hypertension in the clinics utilizing the CDS tool was more than double the rate seen in the clinics that weren’t (55% and 21%, respectively; P less than .001).
More of the children seen in CDS clinics were referred to dietitians or weight loss programs, compared with those seen in the control clinics (17% and 4%, respectively; P = .001).
Those who used the tool reported high levels of satisfaction, which is likely partly because investigators consulted physicians to help design the application.
“The CDS tool was based on the guidelines for BP management in children and adolescents in effect at the time of the study with local input from clinical and operational leaders within the medical group, and thus it contained the so-called right information,” according to Dr. Kharbanda and her fellow investigators.
Of the 55 physicians who remembered using the tool, 92% thought is was useful in identifying hypertension, 94% considered the CDS a good use of time, and 95% believed is was a useful shared-decision making tool.
When designing TeenBP, investigators tailored the application to the work flow and culture of the health system used for the study, which may limit the generalizability of the findings.
The study was funded by the National Institutes of Health. Dr. Kharbanda and her associates reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
Source: Kharbanda EO et al. Pediatrics. 2018. doi: 10.1542/peds.2017- 2954.
Hypertension discovery in pediatric patients more than doubled for physicians using a clinical decision support (CDS) tool connected to the EHR, results of a study found.
Elyse O. Kharbanda, MD, MPH, a researcher at the HealthPartners Institute, Minneapolis, and her fellow investigators assert that using such a tool will help rectify the trend of underreported hypertension in adolescents, which remains a serious concern despite providers’ routinely taking blood pressure measurements during outpatient visits.
“Among patients with multiple visits, electronic health records should contain sufficient information to diagnose hypertension,” Dr. Kharbanda and her associates reported in their article published in Pediatrics. “However, even when EHRs are configured to display BP percentiles, information on the patterns of BP percentiles over time, previous diagnoses, and medications is not presented in a format that is useful for clinicians.”
With TeenBP, providers are first prompted to take an initial BP reading, as well as height and weight measurements.
If the first measure is above the 95th percentile, the CDS requests an additional reading, which is then averaged with the first. If average of the two is above or within the 95th percentile, the provider is notified and sent a list of recommendations, including a diagnosis of hypertension, lipid screening, and nutrition referral.
The 2-year trial included 522 pediatric patients with incident hypertension; the data were gathered from 20 primary care clinics within one health system between April 2014 and April 2016.
The rate of clinical recognition of patients’ hypertension in the clinics utilizing the CDS tool was more than double the rate seen in the clinics that weren’t (55% and 21%, respectively; P less than .001).
More of the children seen in CDS clinics were referred to dietitians or weight loss programs, compared with those seen in the control clinics (17% and 4%, respectively; P = .001).
Those who used the tool reported high levels of satisfaction, which is likely partly because investigators consulted physicians to help design the application.
“The CDS tool was based on the guidelines for BP management in children and adolescents in effect at the time of the study with local input from clinical and operational leaders within the medical group, and thus it contained the so-called right information,” according to Dr. Kharbanda and her fellow investigators.
Of the 55 physicians who remembered using the tool, 92% thought is was useful in identifying hypertension, 94% considered the CDS a good use of time, and 95% believed is was a useful shared-decision making tool.
When designing TeenBP, investigators tailored the application to the work flow and culture of the health system used for the study, which may limit the generalizability of the findings.
The study was funded by the National Institutes of Health. Dr. Kharbanda and her associates reported no relevant financial disclosures.
ezimmerman@frontlinemedcom.com
Source: Kharbanda EO et al. Pediatrics. 2018. doi: 10.1542/peds.2017- 2954.
FROM PEDIATRICS
Key clinical point: Using a clinical decision support (CDS) tool doubles the rate of hypertension detection in children.
Major finding: Providers in clinics that used CDS recognized hypertension in 55% of patients, compared with 21% of patients in usual care (P less than .001).
Study details: Cluster-randomized trial of 522 pediatric patients across 20 primary care clinics who received care between April 2014 and April 2016.
Disclosures: The study was funded by the National Institutes of Health. The investigators reported no relevant financial disclosures.
Source: Kharbanda EO et al. Pediatrics. 2018. doi: 10.1542/peds.2017- 2954.