Decision Support Algorithm

Automatic Reminders to Intensify Therapy –
Decision Support Algorithm

The Automatic Reminders to Intensify Therapy intervention, deployed at Brigham and Women’s Hospital in Boston, Ma., utilized a computerized decision support system that automatically reminded physicians to intensify therapy for their hypertensive patients, when the patients’ blood pressure is uncontrolled or poorly-controlled. The reminders were delivered through the clinics’ electronic medical records, and consisted of suggestions to increase dosage, add, or change medications to treat hypertension.

The automatic reminder system utilized a series of rules that determine what reminders, if any, should be delivered to a provider, based on the specific patient characteristics, diagnosis, and history. The factors evaluated by these rules include patient age, diagnosis of coronary artery disease, congestive heart failure, renal failure, or diabetes mellitus, history of blood pressure screening, current blood pressure measurements, current medication prescription, medication allergies, and serum creatinine levels. Based on those factors, the rules produced either a decision to deliver no reminder, or a reminder tailored to the patient’s needs, that is delivered when the provider accesses the patients’ electronic medical record.

These structured set of rules and outcomes is the algorithm at the heart of the Automatic Reminders intervention. Previous studies had established that automated reminders could increase rates of prescription for appropriate medication, but did not necessarily improve blood pressure control. Those studies did not specifically focus on the intensification of therapy in response to poorly-controlled blood pressure, which is the focus of the Automatic Reminders intervention.

The algorithm utilized in the Automatic Reminders intervention can be downloaded here.

Principal Investigator:

  • LeRoi S. Hicks, MD, MPH (Associate Professor, Brigham and Women's Hospital; Chair of Hospital Medicine at University of Massachusetts Medical School)