Using health information technology to improve hypertension management

Abstract

High-quality medical care requires implementing evidence-based best practices, with continued monitoring to improve performance. Implementation science is beginning to identify approaches to developing, implementing, and evaluating quality improvement strategies across health care systems that lead to good outcomes for patients. Health information technology has much to contribute to quality improvement for hypertension, particularly as part of multidimensional strategies for improved care. Clinical reminders closely aligned with organizational commitment to quality improvement may be one component of a successful strategy for improving blood pressure control. The ATHENA-Hypertension (Assessment and Treatment of Hypertension: Evidence-based Automation) system is an example of more complex clinical decision support. It is feasible to implement and deploy innovative health information technologies for clinical decision support with features such as clinical data visualizations and evidence to support specific recommendations. Further study is needed to determine the optimal contexts for such systems and their impact on patient outcomes.

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

“…This increased attention to the quality of BP care resulted in increased facility-level focus on BP control rates (and rewards for better rates). Some facilities have implemented the hypertension reminder described here, along with a decision support system for hypertension care, 38 or the provision of nurse-or pharmacist-administered behavioral interventions, 39,40 evidencing the VA's commitment to improving BP outcomes. However, the approach used here, whereby clinicians' counseling skills are enhanced through training, has rarely been used to improve BP care in VA. Our results suggest that such an approach, combined with the EMR reminder, could lead to small clinical gains at a relatively small cost for the clinician time required for such training.…”

Using Benefit-Based Tailored Treatment to Improve the Use of Antihypertensive Medications

“…While ambitious, similar changes are already occurring in treatment of hypercholesterolemia, where the ACC-AHA guidelines for treatment of patients with stable ischemic heart disease has recently removed its TTT component, 41 the VA system has changed its quality measures to be consistent with BTT, 42 and treatment decision support systems (though not BTT-based) already exist. 43 Before creating a public access decision tool for BTT, we feel it appropriate to await public vetting of our findings and perhaps await changes in formal guidelines and quality measures. Implementation of this work would be a major challenge, but given the importance of blood pressure treatment we feel that such discussions should be made a priority.…”

Development and Validation of a Clinical and Computerised Decision Support System for Management of Hypertension (DSS-HTN) at a Primary Health Care (PHC) Setting

“…One of the first specific DSS built for managing hypertension, the ATHENA-Hypertension (Assessment and Treatment of Hypertension: Evidence-based Automation built by Stanford Medical Informatics) system [13], a similar knowledge-based DSS like our built DSS, showed that implementation and deployment of clinical decision support was feasible in large clinical settings [14]. Differences in ATHENA system and DSS in drug management, prescription of antihypertensives, availability of physiological testing and risk classification are explained in detail in the File S1.…”