Development of Single-Screen Clinical Decision Support to Increase Guideline-Based Weight Management and Comorbidity Care

项目总结 肥胖相关的高血压现在被诊断为儿童高血压。如果没有诊断和治疗，就是高血压 增加了严重健康后果的可能性。为了解决这个问题，我们必须做好准备 儿科医生曾经专注于前瞻性指导和疾病预防，以监测和治疗儿童 高血压和高血压的超重和肥胖。因为儿童的血压正常值 根据年龄、性别和身高的不同，很难识别出三种血压升高来诊断 高血压。我们的长期目标是：1)确定如何在这一主要业务中支持儿科医生 范式转变，2)改善以指南为基础的体重管理和高血压护理的交付，3)改善 长期的体重管理，以及4)减少未被识别的肥胖相关疾病的发病率。 我们之前的研究表明：(1)特定指南-推荐的体重管理临床实践 是有效的，但太少使用，(2)提供者未能识别超重患者的血压升高 儿童，(3)确定儿童高血压标准是一项复杂的、容易出错的任务，以及(4)这一障碍 对高血压的护理可以通过高血压的临床决策支持来解除。这些结果让我们不禁要问 我们可以整理并向提供商提供所需的信息，以提供基于指南的权重 管理和高血压护理。然而，在起草一个潜在的决策支持系统时，我们遇到了 体重管理和评估指南中的年龄和体重状况差异 高血压。这导致了我们的中心假设：(1)专家共识将解决冲突和协调 基于指南的体重管理和高血压护理建议，以及(2)应用 目前在医学上未得到充分利用的认知工程方法将使我们能够建立一个单一屏幕的重量- 管理加上高血压临床决策支持界面：(1)易于使用(减少 所需的任务步骤)、(2)抗错误(限制认知要求的步骤的数量，包括脑力 计算和召回)，以及(3)有助于有效识别所需的关键信息并采取行动 提供基于指南的体重管理和高血压护理。 我们拟议的研究将通过改变目前的初级保健重量来广泛影响该领域- 管理临床实践范例，包括以指南为基础的高血压护理。如果成功，则 由此产生的临床决策支持模型可以在未来应用于解决其他与肥胖相关的问题 合并症。通过未来的资助，这个完全开发的工具将被用来测试体重管理 此外，高血压临床决策支持改善了体重和血压控制。这部作品很有感染力 支持儿科医生在重大实践范式转变和提供基于指南的权重方面的潜力 管理和高血压护理。这种护理的提供具有极大的潜力，可以减少未来 未经治疗的儿童肥胖和高血压导致的成年心血管疾病。

PROJECT SUMMARY Obesity-related hypertension is now diagnosed in children. If undiagnosed and untreated, hypertension increases the likelihood of serious health consequences. To address this problem, we must prepare pediatricians, once focused on anticipatory guidance and disease prevention, to surveil and treat children with overweight and obesity for high blood pressure and hypertension. Because blood-pressure norms in children vary with age, gender, and height, it is difficult to identify three blood-pressure elevations to diagnose hypertension. Our long-term goals are to: 1) identify how to support pediatricians in this major practice paradigm shift, 2) improve delivery of guideline-based weight-management and hypertension care, 3) improve long-term weight management, and 4) reduce morbidity from unrecognized obesity-related disease. Our previous studies revealed: (1) specific guideline-recommended weight management clinical practices are effective, but too-rarely used, (2) providers fail to recognize elevated blood pressures in overweight children, (3) determining pediatric hypertension criteria is a complex, error-prone task, and (4) this impediment to hypertension care can be removed by hypertension clinical decision support. These results led us to ask if we could collate and present to providers information needed to deliver both guideline-based weight management and hypertension care. However, in drafting a potential decision-support system, we confronted age and weight-status variations in screening and evaluation guidelines for weight management and hypertension. This led to our central hypothesis that: (1) expert consensus will resolve conflicts and coordinate guideline-based recommendations for weight management and hypertension care, and (2) application of cognitive-engineering methods currently underused in medicine will enable us to build a single-screen weight- management plus hypertension clinical-decision-support interface that is: (1) easy to use (reduces number of task steps needed), (2) error-resistant (limits number of cognitively demanding steps, including mental calculations and recall), and (3) helpful for efficiently identifying and taking action on key information needed to deliver guideline-based weight-management and hypertension care. Our proposed research will broadly impact the field by transforming the current primary-care weight- management clinical practice paradigm to include guideline-based hypertension care. If successful, the resulting clinical-decision-support model can be applied in the future to address other obesity-related comorbidities. Through future funding, the fully developed tool will be used to test whether weight-management plus hypertension clinical decision support improves weight and blood-pressure control. This work holds great potential to support pediatricians in a major practice paradigm shift and delivery of guideline-based weight management and hypertension care. Delivery of this care holds great potential for reducing future cardiovascular disease in adulthood from unrecognized, untreated obesity and hypertension in children.