Brigham and Women’s Hospital
Primary care clinics
Hypertension
African American, Latino

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.

Summary Results

Using automated EMR reminders to prompt providers to intensify therapy for patients with poorly controlled hypertension did not increase rates of treatment intensification, but did lower blood pressure in the intervention group by 3.8 mm Hg more than the control group. However, significant racial/ethnic disparities persisted. Among patients with poorly controlled blood pressure, Non-Hispanic Whites had their blood pressure medications intensified 69.5% of the time, compared to 56.8% of the time for non-Hispanic Blacks and 57.4% of the time for Hispanics. Additionally, Hispanics experienced a 4.3 mm Hg smaller decline in mean systolic pressure than non-Hispanics did.

Publications

Principal Investigator:

• LeRoi S. Hicks, MD, MPH (Chair of Hospital Medicine at University of Massachusetts Medical School)