EHR-Based Clinical Decision Support to Improve BP Management in Adolescents

描述（由申请人提供）：青春期高血压（HT）可持续至成年，导致成人心血管疾病发病率和死亡率。国家高血压教育计划（NHBPEP）制定了儿童和青少年高血压诊断和治疗的国家指南;其第四次报告于2004年出版。尽管儿科人群对高血压的认识有所提高，但大多数青少年血压升高仍未被临床识别。导致这种护理差距的因素包括：需要将青少年血压（BP）测量结果转换为基于年龄，性别和身高的BP量表，缺乏对NHBPEP临床指南的熟悉，以及临床遇到的竞争需求。基于电子健康记录（EHR）的临床决策支持（CDS）可用于解决这些障碍，并支持更好地治疗青少年血压和HT升高。在这个项目中，我们将EHR提取的数据与复杂的基于Web的CDS算法相结合，根据NHBPEP指南提供患者特定的床旁临床建议。为了评估这一创新对护理质量和成本的影响，我们随机选择了18家诊所，其中有130名儿科护理提供者（PCP）和大约17，000名青少年患者接受或不接受这种基于EHR的CDS干预。我们假设，干预措施将提高识别和早期管理的血压升高，短期增加的门诊治疗费用将被抵消的长期临床效益，估计使用已建立的计量经济学模型。这一创新项目（a）解决了未被充分认识的青少年高危患者群体，（B）整合了电子健康记录和基于网络的CDS技术，以提供复杂的患者特定的护理点CDS，（c）开发和实施新颖直观的视觉界面，以向PCP传达CDS建议，以及（d）提供对临床医生和决策者有用的临床和成本结果数据。如果基于EHR的CDS干预能够提高对NHBPEP建议的遵守，它将提供一个急需的工具来应对儿童和青少年心血管风险因素上升的新兴问题。此外，无论结果如何，开发和测试的技术将提供许多有用的见解，以推进基于EHR的CDS科学。反过来，这将有助于将对EHR技术的大量公共和私人投资转化为改善青少年健康的结果。

DESCRIPTION (provided by applicant): Hypertension (HT) during adolescence tracks into adulthood, contributing to adult cardiovascular morbidity and mortality. National guidelines for the diagnosis and treatment of hypertension in children and adolescents were developed by the National High Blood Pressure Education Program (NHBPEP); their Fourth Report was published in 2004. Despite heightened awareness of hypertension in pediatric populations, most adolescents with elevated blood pressure remain clinically unrecognized. Factors that contribute to this gap in care include: the need to translate adolescent blood pressure (BP) measures into BP percentiles on the basis of age, gender, and height, lack of familiarity with NHBPEP clinical guidelines, and competing demands at clinical encounters. Electronic health record (EHR)-based clinical decision support (CDS) can be used to address these barriers and support better care of elevated BP and HT in adolescents. In this project, we integrate EHR-extracted data with sophisticated Web-based CDS algorithms to provide patient-specific point-of-care clinical recommendations, in accordance with NHBPEP guidelines. To evaluate the impact of this innovation on quality and cost of care, we randomize 18 clinics with their 130 pediatric care providers (PCP) and their estimated 17,000 adolescent patients to receive or not receive this EHR-based CDS intervention. We hypothesize that the intervention will improve recognition and early management of elevated BP and that short-term increases in outpatient care costs will be offset by longer-term clinical benefits, estimated using established econometric models. This innovative project (a) addresses the under-recognized high-risk patient population of adolescents, (b) integrates EHR and Web-based CDS technology to provide sophisticated patient-specific point-of-care CDS, (c) develops and implements novel and intuitive visual interfaces to communicate CDS recommendations to PCPs, and (d) provides both clinical and cost outcome data useful to clinicians and policymakers. If the EHR- based CDS intervention improves adherence to NHBPEP recommendations, it will provide a much-needed tool to combat the burgeoning problem of rising cardiovascular risk factors in children and adolescents. Further, regardless of outcome, the technology that is developed and tested will provide many useful insights to advance the science of EHR-based CDS. This will, in turn, help translate the massive public and private investments in EHR technology into improved adolescent health outcomes.