Improving Recognition and Management of Hypertension in Youth: Comparing Approaches for Extending Effective CDS for use in a Large Rural Health System (Minnesota)

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Patient-specific and evidence-based treatment recommendations for identification and management of elevated blood pressure and hypertension in youth, delivered via clinical decision support, may promote adherence to clinical practice guidelines and may improve long-term cardiovascular health in an at-risk population.

Project Details - Ongoing

Summary:

Hypertension (HT) and high blood pressure (BP) in youth are early indicators of cardiovascular morbidity and mortality in adulthood. Despite the updated guidance in the 2017 American Academy of Pediatrics (AAP) Clinical Practice Guideline to screen for these conditions, elevated BP and HT are often not clinically recognized. Elevated BP and HT may be overlooked by clinicians for several reasons, including lack of familiarity with the pediatric guidelines, time constraints, and competing clinical demands during primary care visits. Compared to urban youth, children in rural areas have higher rates of obesity, a known risk factor for HT.

In a previous study, the research team developed, implemented, and evaluated an electronic health record (EHR)-linked clinical decision support (CDS) to provide clinicians with patient-specific recommendations for identification and management of elevated BP and HT in youth. The tool proved to be well accepted among providers, becoming the standard of care in over 70 urban and suburban primary care clinics. In this followup study, the research team will disseminate the CDS tool, referred to as Peds & TeenBP, in a large rural health system, to further improve recognition and guideline adherent treatment of HT among adolescents.

The specific aims of the project are as follows:

  • Evaluate the effectiveness of the adapted Peds & TeenBP for repeat BP measurements among youth 6-17 years with an elevated BP measurement. 
  • Evaluate the effectiveness of the adapted Peds & TeenBP for improving HT recognition among youth 6-17 years meeting criteria for HT. 

To measure the impact of Peds & TeenBP implementation, the research team will recruit 45 clinics in primarily rural regions of Minnesota, Wisconsin, and North Dakota. Clinics will be randomly assigned to one of three arms. Fifteen clinics will receive “high-intensity” implementation, which includes the CDS tool with online and in-person trainings and feedback. Fifteen clinics will receive the “low-intensity” implementation and will receive the CDS tool with online training only. The remaining clinics will continue with usual care, without the CDS tool. The research team will collect BP measurement and HT recognition among eligible patients to evaluate the effectiveness of Peds & TeenBP and compare low- and high-intensity approaches to CDS implementation.

Tools such as Peds & TeenBP are crucial in rural areas where adolescent obesity is high and access to pediatric subspecialists is low. The proposed research seeks to advance the standard practice of BP measurement, increase HT recognition, and promote guideline adherent management of HT in rural youth.