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Pre-Procedural Guidelines for Assessing Blood Pressure01:10

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The movement of blood in a human body, commonly referred to as blood flow, is determined by the volume of blood that traverses a certain section of the bodily system per unit time. It is the rhythmic contraction of the heart's ventricles that primarily instigates this movement. As the ventricles contract, blood is forced into the prominent arteries, which then flow from areas of greater pressure to lower pressure areas. This movement continues into smaller arteries and arterioles and...
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Social Risk-Informed Decision Support and Blood Pressure Control in a Primary Care Cluster Randomized Controlled

Brenda M McGrath1, Rachel Gold2,3, Jenna Donovan2

  • 1OCHIN, Inc, Portland, Oregon mcgrathb@ochin.org.

Annals of Family Medicine
|March 10, 2026
PubMed
Summary
This summary is machine-generated.

Integrating social clinical decision support (SCDS) tools into electronic health records (EHRs) improved blood pressure control and social risk documentation in primary care clinics. Hemoglobin A1c control did not significantly differ between groups.

Keywords:
clinical decision supportdisease managementelectronic health recordssocial determinants of heatlh

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Area of Science:

  • Health Informatics
  • Primary Care Medicine
  • Social Determinants of Health

Background:

  • Healthcare systems are integrating social risk data into EHRs to address patient needs beyond clinical care.
  • Social risk factors significantly impact chronic disease management and health outcomes.

Purpose of the Study:

  • To evaluate the impact of EHR-integrated social clinical decision support (SCDS) tools on blood pressure (BP) and hemoglobin A1c (HbA1c) control.
  • To assess whether SCDS tools improve social risk-informed care and documentation in community-based clinics.

Main Methods:

  • A cluster randomized trial was conducted in a primary care network with 6 intervention clinics and 44 control clinics.
  • SCDS tools were embedded in the EHR to support workflows and provide targeted decision support for patients with social risks or uncontrolled chronic conditions.
  • Generalized linear mixed models were used to analyze primary outcomes (BP and HbA1c control) and secondary outcomes (social risk screening and documentation).

Main Results:

  • Blood pressure control showed significantly greater improvement in intervention clinics compared to control clinics over 12 months.
  • No significant differences in hemoglobin A1c control were observed between the intervention and control groups.
  • Intervention clinics demonstrated significantly higher rates of social risk screening and documentation.

Conclusions:

  • EHR-integrated SCDS tools are associated with improved blood pressure control and enhanced documentation of social risks.
  • Embedding social risk data into clinical workflows can support better chronic disease management in primary care settings.