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Randomized Controlled Trial
. 2008 Apr;23(4):429-41.
doi: 10.1007/s11606-007-0403-1.

Impact of computerized decision support on blood pressure management and control: a randomized controlled trial

Leroi S Hicks  1 , Thomas D Sequist, John Z Ayanian, Shimon Shaykevich, David G Fairchild, E John Orav, David W Bates
Affiliations
Randomized Controlled Trial

Impact of computerized decision support on blood pressure management and control: a randomized controlled trial

Leroi S Hicks et al. J Gen Intern Med. 2008 Apr.

Abstract

Background: We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.

Methods: We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients' race/ethnicity using interaction terms.

Measurements and main results: Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients' demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%, P < 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13-1.72]) and the effects of the intervention did not differ by patients' race and ethnicity.

Conclusions: CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed.

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Figures

Figure 1
Figure 1
Flow diagram of clinic randomization and nurse practitioner subject recruitment. We analyzed a total of 2,027 patients receiving care in clinics assigned to either computerized decision support (CDS) for all providers within the practice or no CDS. One clinic from each study arm was subsequently randomized to co-management with a nurse practitioner (NP) for hypertension patients, resulting in 1,048 patients who received usual care without NP co-management, 120 patients who received NP co-management whose provider did not receive CDS, 786 patients who did not receive NP co-management whose provider received CDS, and 73 patients who received NP co-management and whose provider received CDS.
See this image and copyright information in PMC

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