An interventional study of clinical decision support in Hypertension, Blood Pressure and Overweight and Obesity, sponsored by University of Texas Southwestern Medical Center. Completed at 1 site in United States. Open to participants aged 3 Years to 18 Years. Per ClinicalTrials.gov, last updated 2020-05-19.
Sponsored by University of Texas Southwestern Medical Center · Not applicable, Interventional, and Screening
Approaches are needed to help primary-care pediatricians address high blood pressure. This study will test whether an electronic health-record-based tool to address high blood pressure is feasible and improves the evaluation and management of high blood pressure in clinical practice. If successful, this approach can be used to address other lifestyle-related and complex health problems (e.g., dyslipidemia and diabetes), then disseminated and used nationwide.
The investigators have developed a new, electronic health-record (EHR)-based tool that is designed to help pediatricians:
IDENTIFY AND DOCUMENT
ORDER the next action(s) needed per guideline-based recommendations, AND per prior actions taken--including:
The investigators are working on improving this system further with addition of orders for:
The investigators' data suggest that (1) addressing obesity-related comorbidities (in combination with high BMI/overweight/obesity) and more frequent follow-up are associated with weight-status improvement in overweight (OW) children, (2) that parents rank checking for weight-related health problems as the #1 most important recommended weight-management clinical practice, but that (3) comorbidities are infrequently addressed. Thus, to improve weight status, interventions are needed to improve comorbidity identification, evaluation, and management in primary care. Because the investigators' data suggest that identification of high blood pressure is particularly poor, and that identifying blood-pressure elevations in young children at three separate encounters is complex, they are using existing underutilized data to automate addressing high blood pressure/hypertension in an electronic health record system (EPIC-based), and, if successful, applying the method to other obesity-related comorbidities in primary care.
OF NOTE: in developing and pilot-testing this decision support tool, providers wanted access to it for patients without overweight/obesity. Thus, although the trial was borne out of work in weight-management research, the initial trial will focus on all children irrespective of weight status.
Inclusion Criteria for Providers: Pediatric primary care providers practicing at participating clinics that have agreed to have the decision-support system implemented.
Exclusion Criteria for Providers:
Inclusion Criteria for Children:
Exclusion Criteria for Children:
TWO MED ASSIST ALERTS 1. Enter height (when missing) 2. Repeat BP (when high) ONE PROVIDER ALERT 1. BP high \& prior BP/BP%s 2. Defines elev. BP, HTN stage 1-2 with button to enter diagnosis 3. Link to tailored ordersets TAILORED ORDERSETS 1. Elevated BP 1. Button to schedule f-up \<6 m 2. Button for diet/lifestyle counseling/check-out instructions 2. HTN stage 1 1. Buttons to order labs/studies pre-checked for stage 1 recs 2. Button for nephrology referral 3. Button to schedule f-up in 1-2 wk/\<1 m 4. Button for diet/lifestyle counseling/check-out instructions 3. HTN stage 2 1. Buttons to order labs/studies for stage 2 2. Button for nephrology referral (pre-checked) 3. Button to f-up 1 wk 4. Button for diet/lifestyle counseling/check-out instruction
Other: clinical decision support
Decision support system (see description of hypertension decision support system alerts and order sets for details)
High blood pressure addressed
Proportion of patients with high blood pressure addressed post decision-support implementation (vs. pre-), defined as proportion of patients with elevated blood pressures or higher who have one or more diagnosis or orders placed to diagnose, evaluate, or manage hypertension. We will compare the slope of the post- vs. pre-implementation periods to examine change in monthly rate of HTN eval/management (indicated elements ordered/patients eligible) related to decision support that are in excess of secular trends in clinical practice. In the post-implementation period, the denominator will be determined by tracking patient-level decision-support fires. In the pre-implementation period, the denominator will be determined by applying the decision-support algorithm to retrospective data in monthly increments to identify patients who would have been eligible.
Time frame: 4-month time series analysis
Plan to share: No — Data are being obtained under a MU agreement/legal contract
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This study is completed, as verified in May 2020. You cannot join it, but the record below documents what was studied.
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University of Texas Southwestern Medical Center