Key result
Prior blood pressure documentation linked to ~12.4-fold higher odds of repeat discussion in clinical notes.
Why the study?
High blood pressure readings are not always discussed in clinical notes, motivating an evaluation of patient- and visit-level factors associated with note documentation among patients without prior hypertension.
Are specific patient- and visit-level factors associated with the likelihood of discussing high blood pressure measurements in clinical notes?
Cohort (n=27,423)
No
Are specific patient- and visit-level factors associated with the likelihood of discussing high blood pressure measurements in clinical notes?
High blood pressure readings in the absence of a prior diagnosis are frequently undocumented in clinical notes, representing a missed opportunity to address hypertension-related diagnostic inertia.
BACKGROUND: Blood pressure (BP) is routinely measured and recorded at healthcare visits, but high BP (HBP) measurements are not always discussed in clinical notes. Our objective was to identify patient- and visit-level factors associated with discussion of HBP measurements in clinical notes, among patients without prior diagnosis of hypertension. METHODS: Data from 2016 to 2022 for all patients with any BP record of 140/90 mmHg or greater were obtained from University of Iowa Hospitals and Clinics electronic medical records. Patients with any prior hypertension diagnosis were excluded. We used a multi-level regression model to evaluate differences in the rates of discussing HBP. The model included varying intercepts for visit specialty and non-varying slopes and intercepts for patient- and visit-level features. RESULTS: The final sample included 278,766 outpatient visits for 27,423 patients, of which 61,739 visits had HBP. Only 31% of visits with HBP had associated clinical notes with a discussion of HBP. Even in primary-care-related clinics, HBP measurements were discussed in only 70% of visits. Factors associated with decreased odds of HBP being discussed in clinical notes included fever (OR: 0.46; 95%CI: 0.24-0.86) or external injury or pain (0.84; 0.79-0.90), and a larger number of comorbidities (6+: 0.27; 0.22-0.32). Discussion of HBP in clinical notes was more likely among visits of patients with prior visits where HBP was discussed in clinical notes (12.36; 11.75-13.01). CONCLUSIONS: We found that discussion of HBP is relatively uncommon. Increasing discussion of hypertension in clinical notes could decrease hypertension-related diagnostic inertia.
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Chapman et al. (2024) conducted a cohort in High blood pressure without prior diagnosis of hypertension (n=27,423). Prior visit with clinical note discussing high blood pressure vs. No prior visit with clinical note discussing high blood pressure was evaluated on Discussion of high blood pressure or hypertension in the clinical note for a given visit (OR 12.36, 95% CI 11.75-13.01). High blood pressure was discussed in clinical notes in only 31% of eligible visits, but discussion was 12.4 times more likely if the patient had a prior visit note discussing high blood pressure.
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