Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension

Objectives To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure. Methods Two acad...

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Veröffentlicht in:Academic emergency medicine 2007-11, Vol.14 (11), p.1090-1096
Hauptverfasser: Lehrmann, Jill F., Tanabe, Paula, Baumann, Brigitte M., Jones, Molly K., Martinovich, Zoran, Adams, James G.
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container_end_page 1096
container_issue 11
container_start_page 1090
container_title Academic emergency medicine
container_volume 14
creator Lehrmann, Jill F.
Tanabe, Paula
Baumann, Brigitte M.
Jones, Molly K.
Martinovich, Zoran
Adams, James G.
description Objectives To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure. Methods Two academic centers implemented a pre‐post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were ed from the medical record. The policy was disseminated after the initial medical record review. Post—policy dissemination medical record review was conducted within two weeks. Results A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post). Conclusions Knowledge of guidelines did not translate into changes in physician practice. Additional systems‐based approaches are necessary to effectively translate guidelines into clinical practice.
doi_str_mv 10.1111/j.1553-2712.2007.tb02394.x
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Methods Two academic centers implemented a pre‐post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were ed from the medical record. The policy was disseminated after the initial medical record review. Post—policy dissemination medical record review was conducted within two weeks. Results A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post). Conclusions Knowledge of guidelines did not translate into changes in physician practice. Additional systems‐based approaches are necessary to effectively translate guidelines into clinical practice.</description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/j.1553-2712.2007.tb02394.x</identifier><identifier>PMID: 17898244</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Blood pressure ; Clinical medicine ; Diffusion of Innovation ; emergency department ; Emergency services ; Female ; Guideline Adherence ; guidelines ; Health care policy ; Humans ; Hypertension ; Hypertension - therapy ; Information Dissemination ; Knowledge ; knowledge translation ; Male ; Middle Aged ; policy ; Practice Guidelines as Topic ; Practice Patterns, Physicians ; Referral and Consultation ; Retrospective Studies ; Societies, Medical</subject><ispartof>Academic emergency medicine, 2007-11, Vol.14 (11), p.1090-1096</ispartof><rights>Copyright Hanley &amp; Belfus, Inc. Nov 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2460-ef0b8e0c0a5c9b95adb707723d1e9f461294549faf333972928bf10e21f9855a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1553-2712.2007.tb02394.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1553-2712.2007.tb02394.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17898244$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lehrmann, Jill F.</creatorcontrib><creatorcontrib>Tanabe, Paula</creatorcontrib><creatorcontrib>Baumann, Brigitte M.</creatorcontrib><creatorcontrib>Jones, Molly K.</creatorcontrib><creatorcontrib>Martinovich, Zoran</creatorcontrib><creatorcontrib>Adams, James G.</creatorcontrib><title>Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description>Objectives To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure. Methods Two academic centers implemented a pre‐post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were ed from the medical record. The policy was disseminated after the initial medical record review. Post—policy dissemination medical record review was conducted within two weeks. Results A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post). Conclusions Knowledge of guidelines did not translate into changes in physician practice. Additional systems‐based approaches are necessary to effectively translate guidelines into clinical practice.</description><subject>Adult</subject><subject>Blood pressure</subject><subject>Clinical medicine</subject><subject>Diffusion of Innovation</subject><subject>emergency department</subject><subject>Emergency services</subject><subject>Female</subject><subject>Guideline Adherence</subject><subject>guidelines</subject><subject>Health care policy</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - therapy</subject><subject>Information Dissemination</subject><subject>Knowledge</subject><subject>knowledge translation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>policy</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians</subject><subject>Referral and Consultation</subject><subject>Retrospective Studies</subject><subject>Societies, Medical</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkU9P3DAQxaOqqFDoV6giDr0ljP_FcU9dRUtBBcGBni0nO4asvPbWzgry7evVrlqpt_pia-Y3b6z3iuKSQE3yuVrXRAhWUUloTQFkPfVAmeL127vi7E_rfX5Do6pGNOy0-JjSGgCEVPJDcUpkq1rK-VmBP3x4dbh6xvIpGp-cmcbgy2DL6QXLxQbjOBhfdsE5zEyuL3PtGf0wl48vcxqHMU-VnRt9Bl35GNyYW1niZt5inNCnrHdRnFjjEn463ufFz-vlU3dT3T18v-0Wd9VAeQMVWuhbhAGMGFSvhFn1EqSkbEVQWd4QqrjgyhrLGFOSKtr2lgBSYlUrhGHnxZeD7jaGXztMk96MaUDnjMewS7ppOW-4ajJ4-Q-4Drvo8980pdByKRhk6OsBGmJIKaLV2zhuTJw1Ab1PQq_13m69t1vvk9DHJPRbHv583LDrN7j6O3q0PgPfDsDr6HD-D2m96Jb3BBSw34u1mOk</recordid><startdate>200711</startdate><enddate>200711</enddate><creator>Lehrmann, Jill F.</creator><creator>Tanabe, Paula</creator><creator>Baumann, Brigitte M.</creator><creator>Jones, Molly K.</creator><creator>Martinovich, Zoran</creator><creator>Adams, James G.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>200711</creationdate><title>Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension</title><author>Lehrmann, Jill F. ; Tanabe, Paula ; Baumann, Brigitte M. ; Jones, Molly K. ; Martinovich, Zoran ; Adams, James G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2460-ef0b8e0c0a5c9b95adb707723d1e9f461294549faf333972928bf10e21f9855a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Blood pressure</topic><topic>Clinical medicine</topic><topic>Diffusion of Innovation</topic><topic>emergency department</topic><topic>Emergency services</topic><topic>Female</topic><topic>Guideline Adherence</topic><topic>guidelines</topic><topic>Health care policy</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - therapy</topic><topic>Information Dissemination</topic><topic>Knowledge</topic><topic>knowledge translation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>policy</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians</topic><topic>Referral and Consultation</topic><topic>Retrospective Studies</topic><topic>Societies, Medical</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lehrmann, Jill F.</creatorcontrib><creatorcontrib>Tanabe, Paula</creatorcontrib><creatorcontrib>Baumann, Brigitte M.</creatorcontrib><creatorcontrib>Jones, Molly K.</creatorcontrib><creatorcontrib>Martinovich, Zoran</creatorcontrib><creatorcontrib>Adams, James G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lehrmann, Jill F.</au><au>Tanabe, Paula</au><au>Baumann, Brigitte M.</au><au>Jones, Molly K.</au><au>Martinovich, Zoran</au><au>Adams, James G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2007-11</date><risdate>2007</risdate><volume>14</volume><issue>11</issue><spage>1090</spage><epage>1096</epage><pages>1090-1096</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract>Objectives To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure. Methods Two academic centers implemented a pre‐post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were ed from the medical record. The policy was disseminated after the initial medical record review. Post—policy dissemination medical record review was conducted within two weeks. Results A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post). Conclusions Knowledge of guidelines did not translate into changes in physician practice. Additional systems‐based approaches are necessary to effectively translate guidelines into clinical practice.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>17898244</pmid><doi>10.1111/j.1553-2712.2007.tb02394.x</doi><tpages>7</tpages></addata></record>
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subjects Adult
Blood pressure
Clinical medicine
Diffusion of Innovation
emergency department
Emergency services
Female
Guideline Adherence
guidelines
Health care policy
Humans
Hypertension
Hypertension - therapy
Information Dissemination
Knowledge
knowledge translation
Male
Middle Aged
policy
Practice Guidelines as Topic
Practice Patterns, Physicians
Referral and Consultation
Retrospective Studies
Societies, Medical
title Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension
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