Pediatric High Blood Pressure Recognition Associated With Electronic Decision Support: A Cohort Analysis
Justin P Zachariah1, Tavleen Singh2, Shannon Collinson2
1Division of Pediatric Cardiology (J.P.Z., M.H., S.K.S.-T.), Texas Children's Hospital, Baylor College of Medicine, Houston.
Insights
A new initiative improved recognition of high blood pressure (BP) in children and adolescents. This approach enhanced BP measurement and management, even in disadvantaged populations, showing promising results for pediatric cardiovascular health.
Area of Science:
- Pediatric Cardiology
- Public Health Initiatives
- Health Disparities
Background:
- Pediatric high blood pressure (BP) is a predictor of future cardiovascular disease.
- High BP in children is often underdiagnosed and undertreated, particularly in vulnerable populations.
- Effective management strategies are crucial for long-term pediatric health outcomes.
Purpose of the Study:
- To assess the impact of a comprehensive initiative on provider recognition of high blood pressure in a pediatric setting.
- To evaluate the effectiveness of the initiative across diverse patient demographics, including disadvantaged groups.
- To identify improvements in BP measurement, diagnosis, and management following the intervention.
Main Methods:
- A multi-component initiative involving provider retraining, equipment deployment, and an electronic decision support tool was implemented.
- Data on BP and patient characteristics were collected during 14-month pre- and post-intervention periods.
- Incident BP recognition was defined by diagnostic codes, problem list entries, referrals, testing, repeat visits, or antihypertensive prescriptions.
Main Results:
- The proportion of children and adolescents with measured high BP decreased significantly post-intervention (30% to 14% and 15%, respectively).
- Provider recognition of high BP increased by 58% in children and 43% in adolescents.
- Improvements in BP recognition were observed across disadvantaged racial, ethnic, and geographic groups, indicating reduced disparities.
Conclusions:
- A comprehensive initiative effectively improved high blood pressure measurement and provider recognition in pediatric patients.
- The initiative demonstrated success in reaching and benefiting disadvantaged populations, mitigating disparities in care.
- Further research is recommended to address sustained recognition and optimize electronic decision support for pediatric BP management.
Background:
Pediatric high blood pressure (BP) predicts future cardiovascular disease events. High BP is improperly measured, underrecognized, and undermanaged especially in disadvantaged populations. In a large, diverse, academic pediatric practice, we detail the associations of a comprehensive initiative with high BP provider recognition.
Methods:
A comprehensive BP initiative was promulgated including (1) retraining providers and staff on BP management; (2) deploying equipment at 55+ sites; and (3) electronic decision support tool alerting staff and clinicians and suggesting management. During the 14-month preintervention and 14-month postintervention periods, data on BP and patient characteristics were collected. The outcome was incident BP recognition defined as any of the following: BP-specific International Classification of Diseases, Tenth Revision, diagnosis; problem list entry; specialty referral; diagnostic testing; repeat visit; or antihypertensives. Dichotomized as under versus at or over 13 years of age, analyses utilized interrupted time series and multivariable-adjusted logistic regression.
Results:
From preintervention (children, n=105 674; adolescents, n=54 365) to postintervention (children, n=87 917; adolescents, n=56 470), the proportion measured with high BP declined in children and adolescents (30% versus 14% and 30% versus 15%, respectively, each P<0.001). Post-intervention, high BP provider recognition was 58% higher in children (4.6%-7.3%) and 43% higher in adolescents (7.9% versus 11.3%; P<0.001 for both). The improvement was not different in disadvantaged race, ethnicity, or zip codes.
Conclusions:
A comprehensive BP initiative was associated with more appropriate high BP measurement and recognition including in disadvantaged populations. Future work may address the low overall and nonsustained recognition and consideration of electronic decision support for pediatric BP management and mitigating disparities.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.