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Improving Recognition and Management of Hypertension in Youth: Comparing Approaches for Extending Effective CDS for use in a Large Rural Health System

Award Number: R18HS027402
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)
PERIOD OF PERFORMANCE START DATE: 09/30/2020
PERIOD OF PERFORMANCE END DATE: 07/31/2025

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Improving Recognition and Management of Hypertension in Youth: Comparing Approaches for Extending Effective CDS for use in a Large Rural Health System - Project Summary Hypertension (HT) in youth tracks into adulthood, contributing to adult cardiovascular morbidity and mortality. National guidelines for the diagnosis and treatment of HT in children and adolescents were last updated in 2017, with definitions for HT that vary by age. To date, most children and adolescents with elevated blood pressure (BP) or HT are not diagnosed or inadequately treated. Factors that contribute to these deficits in care include: the need to translate pediatric BP measures into BP percentiles, lack of clinician familiarity with pediatric HT guidelines, and competing demands at clinical encounters. Electronic health record (EHR)-linked clinical decision support (CDS) can be used to address these barriers and improve the identification and management of elevated BP and HT in children and adolescents. With funding from NHLBI, our team developed, implemented, and evaluated a sophisticated web-based, EHR-linked CDS to provide patient-specific clinical care recommendations in real time and in accordance with national guidelines for BP management in youth. In a 2-year cluster randomized trial in 20 urban and suburban primary care clinics in an integrated health system in Minnesota, we demonstrated that our CDS increased repeat measurement of elevated BP during a visit and more than doubled clinician recognition of HT, while promoting dietitian referrals and additional next steps in care consistent with national guidelines. The CDS system was well accepted by providers and as such, is now standard of care in 55 primary care and 17 subspecialty clinics serving children across our health system. Implementation of this CDS, now referred to as Peds & TeenBP, in a new health system is a logical next step, yet optimal strategies for adaptation and implementation of CDS in clinics serving rural populations have not been well described. In the current proposal, we will implement Peds & TeenBP in a large health system with many clinics located in rural regions of Minnesota, Wisconsin and North Dakota. In order to compare approaches to implementation of Peds & TeenBP to usual care, we will randomly assign 15 primary care clinics to receive high-intensity implementation (CDS with online and in-person training, and audit-feedback), 15 clinics to receive low-intensity implementation (CDS with online training only), and 15 clinics will continue with usual care (no CDS). Primary outcomes are repeat BP measurement and HT recognition. Secondary outcomes include management of HT and BP control at 12-month follow-up. As rural children face reduced access to pediatric subspecialists, tools such as Peds & TeenBP are needed. The proposed comparison of high-intensity and low-intensity approaches to implementation, with a focus on delivery of a new intervention in a rural healthcare setting, is consistent with AHRQ’s research priorities in providing meaningful decision support while increasing evidence to support adoption across a health system.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $397,480 )
2024	2024	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Research on Healthcare Costs, Quality and Outcomes	000	5	6/21/2024	NON-COMPETING CONTINUATION	$397,480
														Subtotal = $397,480

Issue Date FY: 2023 ( Subtotal = $398,293 )
2023	2023	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	6/28/2023	NON-COMPETING CONTINUATION	$398,293
														Subtotal = $398,293

Issue Date FY: 2022 ( Subtotal = $399,999 )
2022	2022	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	6/27/2022	NON-COMPETING CONTINUATION	$399,999
														Subtotal = $399,999

Issue Date FY: 2021 ( Subtotal = $399,999 )
2021	2021	HEALTHPARTNERS INSTITUTE	3311 E OLD SHAKOPEE RD	BLOOMINGTON	MN	55425	HENNEPIN	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	7/20/2021	NON-COMPETING CONTINUATION	$399,999
2021	2020	HEALTHPARTNERS INSTITUTE	3311 E OLD SHAKOPEE RD	BLOOMINGTON	MN	55425	HENNEPIN	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	12/3/2020	NEW	$0
														Subtotal = $399,999

Issue Date FY: 2020 ( Subtotal = $399,999 )
2020	2020	HEALTHPARTNERS INSTITUTE	3311 E OLD SHAKOPEE RD	BLOOMINGTON	MN	55425	HENNEPIN	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/14/2020	NEW	$399,999
														Subtotal = $399,999

Grand Total All Awards = $1,995,770

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Improving Recognition and Management of Hypertension in Youth: Comparing Approaches for Extending Effective CDS for use in a Large Rural Health System

Award Number: R18HS027402

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

PERIOD OF PERFORMANCE START DATE: 09/30/2020

PERIOD OF PERFORMANCE END DATE: 07/31/2025

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