Clinical Decision Support for the Diagnosis and Management of Adult and Pediatric Hypertension

Abstract

Purpose of Review To review literature from 2016 to 2019 on clinical decision support (CDS) for diagnosis and management of hypertension in children and adults. Recent Findings Ten studies described hypertension CDS systems. Novel advances included the integration of patient-collected blood pressure data, automated information retrieval and management support, and use of CDS in low-resource/developing-world settings and in pediatrics. Findings suggest that CDS increases hypertension detection/control, yet many children and adults with hypertension remain undetected or undercontrolled. CDS challenges included poor usability (from lack of health record integration, excessive data entry requests, and wireless connectivity challenges) and lack of clinician trust in blood pressure measures. Summary Hypertension CDS has improved but not closed gaps in the detection and control of hypertension in children and adults. The studies reviewed indicate that the usability of CDS and the system where CDS is deployed (e.g., commitment to highquality blood pressure measurement/infrastructure) may impact CDS's ability to increase hypertension detection and control.

Correlates of Adherence to the 2017 Clinical Practice Guidelines for Pediatric Hypertension in Safety-Net Clinics: A Two-Year Cross-Sectional Study

“…These findings are consistent with prior studies in pHTN and more broadly, indicating that these tools are effective but have low adoption. 21,27 Thus, more comprehensive and multilevel implementation strategies are needed to increase uptake of effective CDS tools to promote guideline-adherent pHTN diagnosis and management. For example, a stakeholder advisory panel comprising AllianceChicago pediatricians and academic partners identified 18 discrete implementation strategies needed to improve adherence to the 2017 CPG, including education and training, workflow changes, and leadership support.…”

“…18,19 A common strategy employed to try to overcome these barriers is the use of clinical decision support (CDS) tools in the EHR to save time and decrease clinician decision-making burden, and have been shown to improve recognition of pHTN. 20,21 To date, most studies examining pHTN guideline adherence, as well as use of CDS tools, have been conducted using the guidelines in the Fourth Report. The purpose of this study was to examine the rates of adherence to the 2017 CPG, which also included implementation of a CDS tool in the EHR designed to facilitate guideline adherence.…”

“…18,19 A common strategy employed to try to overcome these barriers is the use of clinical decision support (CDS) tools in the EHR to save time and decrease clinician decision-making burden, and have been shown to improve recognition of pHTN. 20,21…”

A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation

“…In contrast, pediatric clinicians using an EHR with such CDS failed to diagnose an alarming 95% of 3- to 17-year-olds whose BP measurements indicated meeting diagnostic criteria for pHTN per the 2017 CPG [ 26 ]. The fact that many children and adults with hypertension remain undetected [ 10 ] demonstrates that, although promising, health information technologies (HIT) used in isolation (i.e., without strategies to support their use and other aspects of the CPG) may be insufficient for guideline-adherent diagnosis and management [ 27 ].…”

Blood pressure percentiles and systemic hypertension-associated factors among children aged between 6 and 15 years in Southern Vietnam

“…In www.journals.viamedica.pl/arterial_hypertension a study from 1999 to 2006 of 14187 children and adolescents aged 3 to 18 years in Cleveland, the United States, 507 of the children (3.6%) had systemic hypertension but only a quarter was diagnosed [2]. The lack of information on pediatric hypertension had a direct detrimental effect on diagnosis and treatment [3,4]. In fact, the standard blood pressure tables were essential to provide recommendations for diagnosis, evaluation, and treatment of systemic hypertension [5].…”