Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial
BACKGROUND We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients. METHODS We randomized 2,027 adult patients receiving hypertensio...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2008-04, Vol.23 (4), p.429-441 |
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| creator | Hicks, LeRoi S. Sequist, Thomas D. Ayanian, John Z. Shaykevich, Shimon Fairchild, David G. Orav, E. John Bates, David W. |
| description | BACKGROUND
We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.
METHODS
We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients’ race/ethnicity using interaction terms.
MEASUREMENTS AND MAIN RESULTS
Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients’ demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%,
P
|
| doi_str_mv | 10.1007/s11606-007-0403-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2359515</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2395252231</sourcerecordid><originalsourceid>FETCH-LOGICAL-c467t-290ab9444149c3b393239b2453fe2c68a3d639130dd3cb8896103151375d9b063</originalsourceid><addsrcrecordid>eNp1kU1v1DAQhi0EokvhB3BBFgduAY_HTmwOSGX5aKUiEJSz5TjeJVVip3aCBL8eL7vqBxInv_Y883pGLyFPgb0ExppXGaBmdVVkxQTDCu6RFUguKxC6uU9WTClRqQbFEXmU8yVjgJyrh-QIFDYIAlYkno2TdTONG7qO47TMPvW_fUffedfnPgb6bZmmmAoQ6Nshxo5-ST7nJXn6yQa79aMPM7WhK-1hTnF4TU_o13KP41-fw-tQ5EXq7fCYPNjYIfsnh_OYfP_w_mJ9Wp1__ni2PjmvnKibueKa2VYLIcomDlvUyFG3XEjceO5qZbGrUQOyrkPXKqVrYAgSsJGdblmNx-TN3nda2tF3rkyZ7GCm1I82_TLR9uZuJfQ_zDb-NBylliCLwYuDQYpXi8-zGfvs_DDY4OOSTcOEUMBZAZ__A17GJYWynFGNrJXkDRYI9pBLMefkN9eTADO7LM0-S7OTuywNlJ5nt1e46TiEVwC-B3Ipha1PNz__3_UPkjWpqA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>875685273</pqid></control><display><type>article</type><title>Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Springer Nature - Complete Springer Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Hicks, LeRoi S. ; Sequist, Thomas D. ; Ayanian, John Z. ; Shaykevich, Shimon ; Fairchild, David G. ; Orav, E. John ; Bates, David W.</creator><creatorcontrib>Hicks, LeRoi S. ; Sequist, Thomas D. ; Ayanian, John Z. ; Shaykevich, Shimon ; Fairchild, David G. ; Orav, E. John ; Bates, David W.</creatorcontrib><description>BACKGROUND
We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.
METHODS
We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients’ race/ethnicity using interaction terms.
MEASUREMENTS AND MAIN RESULTS
Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients’ demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%,
P
< 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13–1.72]) and the effects of the intervention did not differ by patients’ race and ethnicity.
CONCLUSIONS
CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-007-0403-1</identifier><identifier>PMID: 18373141</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Academic Medical Centers ; African Americans ; Aged ; Antihypertensive Agents - classification ; Antihypertensive Agents - therapeutic use ; Blood Pressure - drug effects ; Community Health Centers ; Decision support systems ; Decision Support Systems, Clinical ; Disease management ; European Continental Ancestry Group ; Female ; Healthcare Disparities ; Hispanic Americans ; Hospitals, Group Practice ; Humans ; Hypertension ; Hypertension - drug therapy ; Hypertension - ethnology ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Minority & ethnic groups ; Original ; Original Article ; Practice Patterns, Physicians' - statistics & numerical data ; Primary Health Care ; Quality of care</subject><ispartof>Journal of general internal medicine : JGIM, 2008-04, Vol.23 (4), p.429-441</ispartof><rights>Society of General Internal Medicine 2007</rights><rights>Society of General Internal Medicine 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-290ab9444149c3b393239b2453fe2c68a3d639130dd3cb8896103151375d9b063</citedby><cites>FETCH-LOGICAL-c467t-290ab9444149c3b393239b2453fe2c68a3d639130dd3cb8896103151375d9b063</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359515/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359515/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,725,778,782,883,27907,27908,41471,42540,51302,53774,53776</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18373141$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hicks, LeRoi S.</creatorcontrib><creatorcontrib>Sequist, Thomas D.</creatorcontrib><creatorcontrib>Ayanian, John Z.</creatorcontrib><creatorcontrib>Shaykevich, Shimon</creatorcontrib><creatorcontrib>Fairchild, David G.</creatorcontrib><creatorcontrib>Orav, E. John</creatorcontrib><creatorcontrib>Bates, David W.</creatorcontrib><title>Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>BACKGROUND
We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.
METHODS
We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients’ race/ethnicity using interaction terms.
MEASUREMENTS AND MAIN RESULTS
Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients’ demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%,
P
< 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13–1.72]) and the effects of the intervention did not differ by patients’ race and ethnicity.
CONCLUSIONS
CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed.</description><subject>Academic Medical Centers</subject><subject>African Americans</subject><subject>Aged</subject><subject>Antihypertensive Agents - classification</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Blood Pressure - drug effects</subject><subject>Community Health Centers</subject><subject>Decision support systems</subject><subject>Decision Support Systems, Clinical</subject><subject>Disease management</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Healthcare Disparities</subject><subject>Hispanic Americans</subject><subject>Hospitals, Group Practice</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - ethnology</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minority & ethnic groups</subject><subject>Original</subject><subject>Original Article</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Primary Health Care</subject><subject>Quality of care</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kU1v1DAQhi0EokvhB3BBFgduAY_HTmwOSGX5aKUiEJSz5TjeJVVip3aCBL8eL7vqBxInv_Y883pGLyFPgb0ExppXGaBmdVVkxQTDCu6RFUguKxC6uU9WTClRqQbFEXmU8yVjgJyrh-QIFDYIAlYkno2TdTONG7qO47TMPvW_fUffedfnPgb6bZmmmAoQ6Nshxo5-ST7nJXn6yQa79aMPM7WhK-1hTnF4TU_o13KP41-fw-tQ5EXq7fCYPNjYIfsnh_OYfP_w_mJ9Wp1__ni2PjmvnKibueKa2VYLIcomDlvUyFG3XEjceO5qZbGrUQOyrkPXKqVrYAgSsJGdblmNx-TN3nda2tF3rkyZ7GCm1I82_TLR9uZuJfQ_zDb-NBylliCLwYuDQYpXi8-zGfvs_DDY4OOSTcOEUMBZAZ__A17GJYWynFGNrJXkDRYI9pBLMefkN9eTADO7LM0-S7OTuywNlJ5nt1e46TiEVwC-B3Ipha1PNz__3_UPkjWpqA</recordid><startdate>20080401</startdate><enddate>20080401</enddate><creator>Hicks, LeRoi S.</creator><creator>Sequist, Thomas D.</creator><creator>Ayanian, John Z.</creator><creator>Shaykevich, Shimon</creator><creator>Fairchild, David G.</creator><creator>Orav, E. John</creator><creator>Bates, David W.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</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>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20080401</creationdate><title>Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial</title><author>Hicks, LeRoi S. ; Sequist, Thomas D. ; Ayanian, John Z. ; Shaykevich, Shimon ; Fairchild, David G. ; Orav, E. John ; Bates, David W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-290ab9444149c3b393239b2453fe2c68a3d639130dd3cb8896103151375d9b063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Academic Medical Centers</topic><topic>African Americans</topic><topic>Aged</topic><topic>Antihypertensive Agents - classification</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Blood Pressure - drug effects</topic><topic>Community Health Centers</topic><topic>Decision support systems</topic><topic>Decision Support Systems, Clinical</topic><topic>Disease management</topic><topic>European Continental Ancestry Group</topic><topic>Female</topic><topic>Healthcare Disparities</topic><topic>Hispanic Americans</topic><topic>Hospitals, Group Practice</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - ethnology</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minority & ethnic groups</topic><topic>Original</topic><topic>Original Article</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Primary Health Care</topic><topic>Quality of care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hicks, LeRoi S.</creatorcontrib><creatorcontrib>Sequist, Thomas D.</creatorcontrib><creatorcontrib>Ayanian, John Z.</creatorcontrib><creatorcontrib>Shaykevich, Shimon</creatorcontrib><creatorcontrib>Fairchild, David G.</creatorcontrib><creatorcontrib>Orav, E. 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John</au><au>Bates, David W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2008-04-01</date><risdate>2008</risdate><volume>23</volume><issue>4</issue><spage>429</spage><epage>441</epage><pages>429-441</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>BACKGROUND
We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.
METHODS
We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients’ race/ethnicity using interaction terms.
MEASUREMENTS AND MAIN RESULTS
Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients’ demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%,
P
< 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13–1.72]) and the effects of the intervention did not differ by patients’ race and ethnicity.
CONCLUSIONS
CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>18373141</pmid><doi>10.1007/s11606-007-0403-1</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Springer Nature - Complete Springer Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Academic Medical Centers African Americans Aged Antihypertensive Agents - classification Antihypertensive Agents - therapeutic use Blood Pressure - drug effects Community Health Centers Decision support systems Decision Support Systems, Clinical Disease management European Continental Ancestry Group Female Healthcare Disparities Hispanic Americans Hospitals, Group Practice Humans Hypertension Hypertension - drug therapy Hypertension - ethnology Internal Medicine Male Medicine Medicine & Public Health Middle Aged Minority & ethnic groups Original Original Article Practice Patterns, Physicians' - statistics & numerical data Primary Health Care Quality of care |
| title | Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial |
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