Clinical-Decision Support to Improve Hypertension Care in Primary Care

The investigators' data suggest that (1) addressing obesity-related comorbidities (in combination with high BMI/overweight/obesity) and more frequent follow-up are associated with weight-status improvement in overweight (OW) children, (2) that parents rank checking for weight-related health problems as the #1 most important recommended weight-management clinical practice, but that (3) comorbidities are infrequently addressed. Thus, to improve weight status, interventions are needed to improve comorbidity identification, evaluation, and management in primary care. Because the investigators' data suggest that identification of high blood pressure is particularly poor, and that identifying blood-pressure elevations in young children at three separate encounters is complex, they are using existing underutilized data to automate addressing high blood pressure/hypertension in an electronic health record system (EPIC-based), and, if successful, applying the method to other obesity-related comorbidities in primary care.

OF NOTE: in developing and pilot-testing this decision support tool, providers wanted access to it for patients without overweight/obesity. Thus, although the trial was borne out of work in weight-management research, the initial trial will focus on all children irrespective of weight status.

Inclusion criteria

for Providers: Pediatric primary care providers practicing at participating clinics that have agreed to have the decision-support system implemented.

Exclusion criteria

for Providers:

• Lack of electronic health record

Inclusion criteria

for Children:

• Measured systolic or diastolic blood pressure >=90th % for age/sex, or
• >=120 mmHg systolic or >=80 mmHg diastolic (whichever is lower)

Exclusion criteria

for Children:

• Diagnosis/visit for high blood pressure or hypertension in past 2 years
• Taking anti-hypertensive medication