Improving Pediatric Hypertension Screening in an Academic Primary Care Setting

Area of Science:

• Pediatric Health
• Clinical Practice Guidelines
• Hypertension Management

Background:

• Adherence to American Academy of Pediatrics guidelines for pediatric hypertension screening and management is suboptimal.
• Recognition and documentation of high blood pressure (BP) diagnoses in adolescents (13-20 years) present a significant challenge in general pediatric settings.

Purpose of the Study:

• To enhance the recognition and documentation of hypertension and elevated BP diagnoses in adolescent patients (13-20 years) within general pediatric clinics.
• To improve adherence to evidence-based practices for BP screening and management in pediatric primary care.

Main Methods:

• Implemented interventions focused on standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption.
• Collected data over 27 months, plotting outcomes using a Laney p' chart to track improvements.
• Primary outcome: proportion of visits with a hypertension or elevated BP diagnosis for patients aged 13-20 with BP ≥ 120/80. Secondary outcomes included correct arm measurement, mid-arm circumference recording, and a second BP reading.

Main Results:

• Provider documentation of elevated BP or hypertension significantly improved from a baseline mean of 24% to 41%.
• All assessed secondary outcome measures, including accurate BP measurement techniques, also showed significant improvement.

Conclusions:

• The project successfully demonstrated the feasibility of improving adherence to best practices for BP measurement in primary care.
• Utilizing provider education, resource acquisition, and EHR flags for abnormal values can effectively enhance pediatric hypertension diagnosis and management.