Leveraging Electronic Health Record (EHR) Tools to Reduce Health Disparities for Patients With Uncontrolled Hypertension
- Conditions
- HypertensionBlood Pressure
- Interventions
- Behavioral: REDUCE-BP Intervention
- Registration Number
- NCT05030467
- Lead Sponsor
- Brigham and Women's Hospital
- Brief Summary
A two-arm cluster randomized controlled trial targeting primary care providers will be conducted to evaluate the impact of a multicomponent electronic health record (EHR) intervention on hypertension management. Given the cluster trial design, randomization will be conducted at the site level, and in the intervention sites, all eligible providers will receive the intervention. The intervention consists of enhancing tools already available to primary care providers in the EHR system, including developing and implementing provider disparities dashboards, enhancing electronic decision support, and simplifying self-monitoring orders and communication materials. The intervention aims to improve blood pressure control and reduce health disparities in racial and ethnic minorities. Findings from this trial will provide important insight into whether a multicomponent intervention targeting providers and leveraging health information technology can reduce health disparities.
- Detailed Description
The goal of this project is to improve existing decision support for hypertension control and to reduce disparities in treatment, consistent with Advocate-specific professional guidelines and quality metrics. To achieve this, a cluster randomized trial will be conducted and evaluated to determine whether health IT tools targeted to providers improve blood pressure control for patients with uncontrolled hypertension.
The primary hypothesis is that a health IT intervention will improve systolic blood pressure (primary outcome), concordance with hypertension guidelines (secondary outcome), diastolic blood pressure (secondary outcome), treatment intensification (secondary outcome), controlled blood pressure (secondary outcome) and systolic blood pressure disparities (secondary outcome) compared with usual care.
Participating clinics will be randomly assigned to one of 2 arms: (a) Arm 1: multicomponent, intervention and (b) Arm 2: usual care (i.e. no intervention). Providers and in each arm will receive the same intervention for up to 24 months after randomization, which will demonstrate the relative effectiveness of each approach as well as its long-term impact on clinical outcomes. Primary care providers in the intervention clinics will receive electronic decision support tools to guide their care of eligible patients. Providers in usual care clinics will receive usual care at Advocate Aurora Health (AAH). Patients will not receive any intervention or outreach independent of their provider or care team. EHR data will be used to implement the EHR tools, identify study subjects, track study progress, and evaluate the effect of the interventions. Patients will only be included in the analysis and will not be directly enrolled or contacted by investigators; we expect at least 2000 patients to be included in the analysis.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 49932
- Medical Group Medical Home Population: 1 visit with Primary Care Physician (PCP) in past 2 years (rolling 24 months) and Patient has a medical group PCP as their EPIC General PCP
- Current age 18-85 years
- Hypertension diagnosis on EPIC Problem list OR at least 2 visits (office/telehealth/telephonic) with an encounter diagnosis of hypertension on different dates, with any during the last 24 months (rolling dates) performing provider
- Latest outpatient/ambulatory (exclude urgent care) systolic blood pressure ≥140 or diastolic blood pressure ≥90 (12 months rolling) (lowest measure if more than one taken at the same time)
- Patients not meeting the inclusion criteria above will not be included in the analysis of the study. No other exclusion criteria will be used.
Among these eligible patients, patients included in the primary analysis will be those that had an in-person visit at one of the trial clinics.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Arm REDUCE-BP Intervention Providers within the clinics randomized to the intervention arm will receive a variety of EHR-based tools for eligible patients with uncontrolled hypertension.
- Primary Outcome Measures
Name Time Method Change in systolic blood pressure 12 months Change in systolic blood pressure from identification to the end of the 12-month follow-up, using values in the EHR from ambulatory care encounters
- Secondary Outcome Measures
Name Time Method Change in diastolic blood pressure 12 months Change in diastolic blood pressure from identification to 12-month follow-up, measured using values in the EHR
Percentage of patients with intensification of medication 12 months Percentage of patients with intensification of medication in the 12-month follow-up period, defined by addition of therapy or increasing dose
Percentage of patients with well-controlled blood pressure 12 months Percentage of patients with well-controlled blood pressure (\<140/88mmHg) in the 12-month follow-up period, using values in the EHR from ambulatory care encounters
Systolic blood pressure differences 12 months Change in the gap in systolic blood pressure between Black and Hispanic/Latino patients and non-Hispanic patients from identification to the end of the 12-month follow-up, measured using values in the EHR from ambulatory care encounters
Percentage of patients with guideline-concordant medications 12 months Percentage of patients with guideline-concordant medications ordered in the follow-up period
Trial Locations
- Locations (1)
Advocate Health Care
🇺🇸Chicago, Illinois, United States