Hicks LS et al. 2008 "Impact of computerized decision support on blood pressure management and control: a randomized controlled trial."
Reference
Hicks LS, Sequist TD, Ayanian JZ, et al. Impact of computerized decision support on blood pressure management and control: a randomized controlled trial. J Gen Intern Med 2008;23(4):429-441.
Abstract
"BACKGROUND: We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.
METHODS: We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients' race/ethnicity using interaction terms.
MEASUREMENTS AND MAIN RESULTS: Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients' demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%, P< 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13-1.72]) and the effects of the intervention did not differ by patients' race and ethnicity.
CONCLUSIONS: CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed."
METHODS: We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients' race/ethnicity using interaction terms.
MEASUREMENTS AND MAIN RESULTS: Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients' demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%, P< 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13-1.72]) and the effects of the intervention did not differ by patients' race and ethnicity.
CONCLUSIONS: CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed."
Objective
"To examine the effectiveness of CDS [clinical decision support], designed to remind physicians about hypertension treatment guidelines with the goals of: (1) improving levels of blood pressure control, (2) improving provider adherence with recommended drug therapy, and (3) reducing racial/ethnic disparities in hypertension care and outcomes."
Type Clinic
Primary care
Size
Large
Geography
Urban
Other Information
Clinic types included: women's health, general primary care, community and non-community health centers. All were "affiliated with a large urban academic medical center."
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
"Each time that a clinician opened a patient's chart, an algorithm was run within the EMR to determine whether the patient was receiving a medication in an antihypertensive drug class in accordance with [Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure] guidelines. The algorithm searched patients' vital signs, problem lists, medication lists, and allergy lists within the electronic record." The CDS was automatically generated for patients with hypertension, and clinicians "received the appropriate reminders. Reminders were displayed within the EMR on the main patient summary screen when the patient's record was accessed."
Context or other IT in place
"All of the clinics involved in the study used EMR [electronic medical records], including electronic prescribing of medications, for each patient during the study period."
Workflow-Related Findings
"Providers randomized to CDS were more likely to prescribe the recommended drug class when compared to controls (7% versus 5%, P<.001). After multivariable adjustment, providers practicing in intervention clinics remained significantly more likely to prescribe a recommended drug than controls (P=.002)."
Study Design
Randomized controlled trial (RCT)
Study Participants
Participants included 2,027 "adult patients with at least 1 hypertension-related outpatient visit to one of the study clinics during the one-year period before the beginning of the interventions;" A total of 1,048 (52 percent) received care in the clinics without CDS, 786 (39 percent) received care in the clinics with CDS, 120 (6 percent) received care in clinics without CDS but providing specialized care by nurse practitioners, and 73 (4 percent) received care in the clinics with CDS that also provided specialized care by nurse practitioners.