Personalizing Intervention to Reduce Clinical Inertia in the Treatment of Hypertension

We propose a pragmatic randomized controlled trial to test two interventions targeting clinical inertia in hypertension compared to control, followed by predictive modeling to identify factors that are associated with intervention responsiveness.

For Aim 1, we will use Electronic Health Record (EHR) data to identify physicians of patients whose hypertension treatment was not intensified despite their having persistently elevated blood pressure. We will then randomize primary care physicians to on of three arms: academic e-detailing, social norming, or no intervention (control).

For Aim 2, we will conduct interviews with select physicians from each arm. We will then identify patient and physician characteristics that are associated with inertia and with responsiveness to each intervention.

Provider Inclusion Criteria:

• Primary care physician
• Practicing in primary care at Massachusetts General Hospital
• Caring for at least 2 patients: (1) aged 18-79, (2) for whom the recent BP history in the last 18 months is above goal, (3) whose most recent BP at an outpatient visit was above goal, and (4) who did not have their hypertension treatment regimens intensified (dose increase, new medication, or medication exchange) at or since that time. The BP goal will be <140/90 for all patients. To accommodate changes in care delivery that occurred during the COVID surge, outpatient visits will include in-office and virtual visits that had vitals recorded in the EHR the same day.

Provider Exclusion Criteria:

• fewer than 100 patients on their primary care panel
• practice less than one session per week

Patient Inclusion Criteria:

• had a blood pressure greater than 140/90 mmHg at 2+ PCP visits in the past 12 months
• treatment was not intensified at any of these visits

Patient Exclusion Criteria:

• excluded from the hypertension registry
• currently pregnant or post-partum 6 months
• receiving hospice care