Patient-Facing Clinical Decision Support to Improve Blood Pressure

Patient involvement is key to blood pressure management

Nearly half of adults in the United States have high blood pressure, which is a major factor in heart attacks, strokes, and kidney disease. Health management is essential to patients with high blood pressure, as lifestyle changes can significantly reduce blood pressure to healthy levels, but maintaining their engagement and motivation is a challenge. Dr. David Dorr, an internal medicine doctor and the chief research information officer at the Oregon Health and Science University, and his research team hypothesized that a patient-facing tool with robust CDS that provides the right information at the right time in the right format through the right channel could help patients better manage their blood pressure. Encouraging patients to set goals, like limiting salt/sodium intake and increasing physical activity, has shown to promote a patient’s participation in blood pressure management while increasing care teams’ understanding of patients’ cardiovascular health.

Motivating patients to manage high blood pressure

Dr. Dorr and his team wanted to understand patient needs and preferences to inform how they could adapt CDS to better engage patients in controlling their high blood pressure. They interviewed and surveyed patients and care teams on their attitudes toward clinical practice guidelines for high blood pressure and patient-facing CDS tools. The feedback obtained served as the foundation for the creation of their tool, called Collaboration Oriented Approach for Controlling High Blood Pressure (COACH). COACH, using interoperable standards, incorporates adapted clinical blood pressure recommendations and best practices to provide an individualized display of information for the purposes of helping a patient manage their high blood pressure.

“We built a machine-encodable version of the recommendations that are intended for patients and then made the information available in an implementation guide and built COACH, which brings together the recommendations into a tool that connects to our electronic health record.”
- Dr. David Dorr

Adaptation is required but feasible to help patients manage blood pressure

The research team iteratively tested the tool using simulated and real patient data. They found that patients and providers were ready to engage with COACH and provided substantial guidance on COACH’s optimization. They engaged patients to make sure the recommendations were understandable and felt appropriate and actionable. They also learned that COACH requires careful adaptation of clinical guidelines and identifying motivators for patient engagement. These lessons learned led to the development of an implementation guide to support replication and successful implementation in other organizations. Next steps, through a future study, include expanding COACH’s usefulness to people with lower digital literacy and testing its visualizations, reminders, and tailored messages in more real-world settings.