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

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

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.

Young at Heart: Improving Hypertension Management in Kids

Young at Heart: Improving Hypertension Management in Kids

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.

Getting youth on a healthy path

Elevated blood pressure (BP) and hypertension (HT) in children are early signs of cardiovascular issues in adulthood, though they often go undiagnosed. Pediatric providers have lots of competing clinical demands in a well-child visit, and may be unfamiliar with pediatric cardiovascular guidelines, missing the opportunity to diagnose and address high BP and HT in kids. As researchers and doctors who are familiar with the stress of trying to identify and address all conditions in a time-constrained visit, Dr. Elyse Kharbanda and Dr. Catherine Benziger wanted to find a way to support providers with a tool that would identify high BP and HT, and provide recommendations to guide patients and their families on a healthier path.

This tool is hopefully helping providers do the right thing. Though it won’t come up frequently for providers, it will not overburden, and ultimately, the tool will help them make the diagnosis and provide education to kids and their families.”
- Dr. Benziger

A tool to guide the way

In a previous study, Dr. Kharbanda and a HealthPartners Institute-based research team developed, implemented, and evaluated an electronic health record-linked clinical decision support (CDS) tool to provide clinicians with patient-specific recommendations for identification and management of elevated BP and HT in youth, finding that the tool was accepted by providers and, more importantly, improved diagnosis. This time around, the team partnered with Dr. Benziger and the Essentia Institute of Rural Health research team to broadly disseminate the CDS tool, called Peds & TeenBP, in 45 Essentia Health clinics in rural regions of Minnesota, Wisconsin, and North Dakota. Fifteen of the clinics received “high-intensity” training—both online and in-person—for providers to use the tool. The team is studying the effectiveness of the tool in improving recognition and management of BP and HT in kids ages 6-17 years, and the impact training has on providers.

Disseminating evidence-based care

Tools such as Peds & TeenBP are crucial in rural areas where adolescent obesity is high and access to pediatric subspecialty care is limited. Both Dr. Kharbanda and Dr. Benziger predict promising outcomes for the clinics using Peds & TeenBP, “being able to bring the guidelines and best evidence to pediatric and primary care providers will help improve the quality of care that the kids in rural areas receive.” The research team hopes to advance the standard practice of BP measurement, increase HT recognition, and promote BP and HT education among pediatric providers and the kids and families they serve.