Optimizing Display of Blood Pressure Data to Support Clinical Decision Making

 描述(申请人提供)：7800万名美国成年人被诊断为高血压，其中近一半的人血压不受控制。医生了解不受控制的高血压的风险，有多种药物类别可用于治疗这个问题。然而，我们努力适当地控制确诊患者的高血压。一个原因是，尽管在门诊诊所测量的血压是一个已知的数字，但这种测量是否足以确定治疗方案往往存在问题。由患者进行的家庭血压监测通常被认为是解决这一问题并更好地确定患者在临床环境之外的血压范围的一种手段。这些家庭测量为这个问题带来了更多的数据，但并没有增加答案的清晰度。这种清晰度的缺乏可能会导致临床惰性、延迟的现象 尽管有数据支持增加治疗，但仍有强化治疗的趋势。最后，治疗计划经常涉及患者和医生之间的协商。这种性质的成功谈判是以对控制权的共同理解为前提的。我们建议，在门诊期间改进血压数据的图形显示将有助于医生和患者更好地了解患者血压问题的范围，并帮助他们就是否需要进行潜在的治疗或治疗修改达成共同决定。因此，我们建议解决血压数据显示这一重要问题，以满足医生和门诊患者在护理点的信息需求，这是识别和管理高血压的一个关键方面。我们试图了解医生和患者如何感知血压的图形显示，以及显示的形式是否影响感知和结果。我们还将调查这些图表中应该包括哪些信息，包括数据量和数据类型(临床血压、家庭血压、药物和数据摘要)。根据医生和患者的输入，结合可用性和设计原则，我们将反复优化TST候选显示，然后将其形式化。最后，我们将试图了解血压数据的图形呈现如何影响患者与医生就诊时的共同决策，包括对共同的控制感和临床结果的调查。

 DESCRIPTION (provided by applicant): Seventy-eight million US adults have diagnosed hypertension, and nearly half of them have uncontrolled blood pressure. Physicians understand the risks of uncontrolled hypertension, and there are multiple drug classes available to treat the problem. Nevertheless, we struggle to appropriately control hypertension in diagnosed patients. One reason is that although the blood pressure measured in the ambulatory clinic is a known number, there is often a question of the adequacy of this measurement for determining treatment. Home blood pressure monitoring by the patient is often proposed as a means to address this problem and to better define the patient's blood pressure range outside the clinical setting. These home measurements bring yet more data to the question, without adding clarity to its answer. This lack of clarity may contribute to the phenomenon of clinical inertia, the delay of treatment intensification despite data, which support an increase in therapy. Lastly, treatment planning frequently involves negotiation between patient and physician. Successful negotiations of this nature are predicated on a shared understanding of control. We propose that improved graphic display of blood pressure data during the clinic visit will help physicians and patients better understand the scope of the patient's blood pressure problem and assist them in reaching a shared decision about the need for potential treatment or treatment modification. Therefore, we propose to address the important issue of blood pressure data display to satisfy the information needs of the physician and ambulatory patient at the point of care, which is one key facet of identifying and managing hypertension. We seek to understand how graphic displays of blood pressure are perceived by physicians and patients, and whether the form of the display influences perceptions and outcomes. We will also investigate what information should be included in these graphs, including both the amount and type of data (clinic blood pressure, home blood pressure, medications, and data summaries). Based on physician and patient input, in conjunction with usability and design principles, we will iteratively refine and then formally tst candidate displays. Finally, we will seek to understand how graphic presentation of blood pressure data influences shared decision making in patient visits with their physicians, including an investigation of shared perceptions of control, and of clinical outcomes.