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)一直持续到成年，导致成人心血管疾病的发病率和死亡率。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；他们的第四份报告于2004年发表。尽管儿童人群对高血压的认识有所提高，但大多数患有高血压的青少年在临床上仍未被认识到。造成这种护理差距的因素包括：需要根据年龄、性别和身高将青少年血压测量转换为血压百分位数，不熟悉NHBPEP临床指南，以及临床上相互竞争的需求。基于电子健康记录(EHR)的临床决策支持(CDS)可以用来解决这些障碍，并支持更好地护理青少年高血压和高血压。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，以根据NHBPEP指南提供患者特定的护理点临床建议。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家诊所及其130名儿科护理提供者(PCP)和他们估计的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，干预将改善对血压升高的认识和早期管理，使用已建立的计量经济学模型估计，门诊护理成本的短期增长将被长期临床收益所抵消。这一创新项目(A)针对未得到充分认识的青少年高危患者群体，(B)整合电子病历和基于网络的CDS技术，以提供复杂的针对特定患者的CDS，(C)开发和实施新颖和直观的可视化界面，向PCP传达CDS建议，以及(D)提供对临床医生和政策制定者有用的临床和成本结果数据。如果基于EHR的CDS干预提高了对NHBPEP建议的遵从性，它将提供一个亟需的工具来应对儿童和青少年心血管危险因素上升这一日益严重的问题。此外，无论结果如何，开发和测试的技术将为推进基于EHR的CDS的科学提供许多有用的见解。反过来，这将有助于将对电子健康记录技术的大规模公共和私人投资转化为改善青少年的健康结果。

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.