Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE

Area of Science:

• Pediatric Health
• Quality Improvement Science
• Clinical Practice Management

Background:

• Childhood hypertension recognition is critical but frequently missed by pediatricians.
• Failure to identify elevated blood pressure (BP) in children can lead to long-term health issues.
• Primary care settings are key for early detection and intervention of pediatric hypertension.

Purpose of the Study:

• To investigate the effectiveness of a quality improvement collaborative (QIC) in reducing missed elevated blood pressure (BP) in primary care pediatric settings.
• To assess if a QIC intervention can improve the documentation of appropriate actions for identified elevated BP in children.
• To determine if improvements in pediatric elevated BP management are sustainable over time.

Main Methods:

• A cluster-randomized clinical trial involving 43 primary care practices was conducted.
• Practices participated in a QIC intervention focused on reducing errors, including missed elevated BP.
• Mixed-effects logistic regression models analyzed the percentage of patients with elevated BP receiving appropriate actions before, during, and after the intervention.

Main Results:

• The mean percentage of patients with elevated BP receiving appropriate actions increased from 58% in the control phase to 74% in the intervention phase (RD 16%).
• Improvements were sustained during subsequent intervention periods and a maintenance phase, with no significant worsening observed.
• The QIC intervention demonstrated a statistically significant improvement in the management of pediatric elevated BP.

Conclusions:

• A quality improvement collaborative (QIC) intervention is an effective strategy for sustainably reducing missed pediatric elevated blood pressure (BP).
• The QIC model provides a viable framework for improving error reduction in other areas of pediatric primary care.
• Sustained improvements in clinical practice can be achieved through structured quality improvement initiatives.