Automatic Reminders to Intensify Therapy
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Brigham and Women’s Hospital
Boston
Hypertension
Primary care clinics
African Americans, Latinos
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PROJECT
Doctors receive automatic reminders to intensify therapy for patients with uncontrolled hypertension.
A computerized decision support system automatically reminds physicians to intensify therapy when a patient has uncontrolled hypertension. The messages are delivered via electronic medical records to physicians whenever they access the record of a patient who meets inclusion criteria. If the patient’s most recent blood pressure reading indicates poor control, the patient’s electronic health record displays a message that is automatically sent to the provider suggesting they intensify anti-hypertensive therapy. The reminders consist of suggestions to increase dosage, add, or change medications to treat hypertension.
A network of 14 primary care clinics that are part of Brigham and Women’s Hospital are participating. Brigham and Women’s Hospital utilizes an integrated longitudinal electronic medical record system that tracks patient information, including outpatient prescriptions.
RATIONALE
Providers may take a more or less aggressive approach to hypertension management depending on a patient’s race or ethnicity, resulting in greater rates of uncontrolled blood pressure for minority patients. This intervention aims to help providers improve the quality of care for all patients by providing automatic notifications to intensify therapy for uncontrolled hypertension. Computer-based reminders have been shown to be effective in improving processes of care, but this study has the potential to demonstrate improved clinical outcomes. By prompting the appropriate intensification of therapy, this study may help overcome clinical inertia and reduce racial and ethnic disparities in hypertension treatment. The cost-effectiveness evaluation may show improvement in clinical outcomes that also show savings in overall health care costs, which could encourage similar interventions elsewhere.
EVALUATION PLAN
Funded by Finding Answers in 2009.
This intervention is being evaluated using an 18-month cluster-randomized controlled trial. Clinics are being stratified by location and practice type, and are being randomized within each strata to either the intervention arm or the control arm. Within the intervention arm, all physicians receive the automatic reminders for qualifying patients. While the cluster randomized intervention is at a clinic level, all outcomes are being measured at a patient level.
The study is examining rates and disparities in blood pressure control and intensification of anti-hypertensive therapy, as well as the effectiveness of the intervention in improving clinical outcomes. The project is also incorporating implementation and cost analysis. This analysis is calculating the average cost per patient in each of the study arms and comparing the difference in costs to differences in proportions of patients obtaining appropriate blood pressure control.
Principal Investigator:
- LeRoi S. Hicks, MD, MPH (Assistant Professor, Brigham and Women's Hospital)
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