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

提高青少年高血压的认识和管理：比较在大型农村卫生系统中推广有效 CDS 的方法

• 批准号: 10454225
• 负责人: Catherine Pastorius Benziger
• 金额: $ 40万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10454225
• 关键词: Improving; Recognition; Management; Hypertension; Youth

Project Summary Hypertension (HT) in youth tracks into adulthood, contributing to adult cardiovascular morbidity and mortality. National guidelines for the diagnosis and treatment of HT in children and adolescents were last updated in 2017, with definitions for HT that vary by age. To date, most children and adolescents with elevated blood pressure (BP) or HT are not diagnosed or inadequately treated. Factors that contribute to these deficits in care include: the need to translate pediatric BP measures into BP percentiles, lack of clinician familiarity with pediatric HT guidelines, and competing demands at clinical encounters. Electronic health record (EHR)-linked clinical decision support (CDS) can be used to address these barriers and improve the identification and management of elevated BP and HT in children and adolescents. With funding from NHLBI, our team developed, implemented, and evaluated a sophisticated web-based, EHR-linked CDS to provide patient-specific clinical care recommendations in real time and in accordance with national guidelines for BP management in youth. In a 2-year cluster randomized trial in 20 urban and suburban primary care clinics in an integrated health system in Minnesota, we demonstrated that our CDS increased repeat measurement of elevated BP during a visit and more than doubled clinician recognition of HT, while promoting dietitian referrals and additional next steps in care consistent with national guidelines. The CDS system was well accepted by providers and as such, is now standard of care in 55 primary care and 17 subspecialty clinics serving children across our health system. Implementation of this CDS, now referred to as Peds & TeenBP, in a new health system is a logical next step, yet optimal strategies for adaptation and implementation of CDS in clinics serving rural populations have not been well described. In the current proposal, we will implement Peds & TeenBP in a large health system with many clinics located in rural regions of Minnesota, Wisconsin and North Dakota. In order to compare approaches to implementation of Peds & TeenBP to usual care, we will randomly assign 15 primary care clinics to receive high-intensity implementation (CDS with online and in-person training, and audit-feedback), 15 clinics to receive low-intensity implementation (CDS with online training only), and 15 clinics will continue with usual care (no CDS). Primary outcomes are repeat BP measurement and HT recognition. Secondary outcomes include management of HT and BP control at 12-month follow-up. As rural children face reduced access to pediatric subspecialists, tools such as Peds & TeenBP are needed. The proposed comparison of high-intensity and low-intensity approaches to implementation, with a focus on delivery of a new intervention in a rural healthcare setting, is consistent with AHRQ’s research priorities in providing meaningful decision support while increasing evidence to support adoption across a health system.

项目摘要 高血压（HT）在青年跟踪到成年，有助于成人心血管疾病的发病率和死亡率。 儿童和青少年HT诊断和治疗的国家指南最近一次更新于 2017年，HT的定义因年龄而异。到目前为止，大多数儿童和青少年血液 血压（BP）或HT未被诊断或治疗不当。导致护理缺陷的因素 包括：需要将儿科BP测量转化为BP量表，临床医生缺乏对 儿科HT指南和临床遇到的竞争需求。 与电子健康记录（EHR）相关的临床决策支持（CDS）可用于解决这些障碍 提高儿童和青少年血压和高血压的识别和管理。与 从NHLBI的资金，我们的团队开发，实施，并评估了一个复杂的基于网络的，EHR链接 CDS根据国家标准，真实的时间提供患者特定的临床护理建议 青少年BP管理指南。在一项为期2年的随机分组试验中，20个城市和郊区小学 在明尼苏达州的综合卫生系统的护理诊所，我们证明了我们的CDS增加了重复 在就诊期间测量血压升高，使临床医生对HT的认识增加了一倍以上， 营养师推荐和符合国家指导方针的后续护理步骤。CDS系统是 被提供者广泛接受，因此现在是55个初级保健和17个专科诊所的标准护理 在我们的卫生系统中为儿童服务。实施该CDS，现称为Peds & TeenBP， 一个新的卫生系统是一个合乎逻辑的下一步，但最佳战略的适应和实施的CDS， 为农村人口服务的诊所没有得到很好的描述。 在目前的提案中，我们将在一个大型卫生系统中实施Peds & TeenBP，该系统中有许多诊所， 明尼苏达州、威斯康星州和北达科他州的农村地区。为了比较各种执行办法， Peds & TeenBP到常规护理，我们将随机分配15个初级保健诊所接受高强度 实施（在线和面对面培训的CDS，以及培训反馈），15个诊所接受低强度 此外，15个诊所将继续提供常规护理（无CDS）。初级 结果是重复BP测量和HT识别。次要结局包括HT的管理 12个月随访时血压控制。由于农村儿童接触儿科专科医生的机会减少， 比如Peds & TeenBP。高强度和低强度方法的拟议比较 实施，重点是在农村卫生保健环境中提供新的干预措施，符合 AHRQ的研究重点是提供有意义的决策支持，同时增加证据支持 在整个卫生系统中采用。