Why the study?
Hypertension is increasing in pediatric populations, but blood pressure is often overlooked due to distrust in readings, visit time constraints, and discomfort prescribing antihypertensive medications.
Does a multistage quality improvement project improve blood pressure measurement accuracy and hypertension diagnosis in an adolescent outpatient setting?
Does a multistage quality improvement project improve blood pressure measurement accuracy and hypertension diagnosis in an adolescent outpatient setting?
A multistage quality improvement project involving staff training and electronic health record alerts can improve the accuracy of blood pressure measurements and hypertension diagnosis in adolescent outpatient settings.
Supports QI with training and EHR alerts to boost adolescent hypertension diagnosis accuracy; extends pediatric outpatient evidence while needing confirmatory trials.
INTRODUCTION: Hypertension (HTN) is increasing in the pediatric population, and hypertensive children become hypertensive adults. Blood pressure (BP) is often overlooked due to factors including distrust in readings, lack of time in visits, and discomfort prescribing antihypertensive medications. The objective of our multistage, clinically based quality improvement project was to improve BP measurement and HTN diagnosis and intervention in adolescents. METHODS: Study investigators performed interventions in an adolescent medicine clinic at Children's Hospital Colorado (ages 12-24 years), which included equipment inventory, mapping clinic processes, manual/automated BP training for staff, education of faculty/staff on guidelines, and creation/implementation of updated best practice alerts (BPAs) based on age-appropriate guidelines for stage 1, 2 HTN in patients younger/older 18years. RESULTS: With equipment updates, medical assistant manual BP certifications, educational sessions for faculty/staff, and creation of a BPA with instruction before the go-live date, confidence in using automated and manual BP measurements increased for faculty/staff. The number of unique patient visits presenting with elevated BPs decreased significantly in the postintervention period reflecting the education/training. Staff used the new order set minimally, but there was an increase in correct diagnoses of elevated BP and laboratory workup. CONCLUSIONS: Having appropriate equipment while introducing BP guideline education in the ambulatory setting with electronic health record reminders and utility of BPAs can decrease erroneous BP values saving providers and staff encounter time. Real-time alerts can aid in accurate diagnosis rates and improved intervention for youth with elevated BP readings. Providers still inconsistently interact with order sets despite such parameters.
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Woods et al. (2021) studied Hypertension. Quality improvement project (training, education, and best practice alerts) vs. Pre-intervention period was evaluated on Blood pressure measurement accuracy and hypertension diagnosis rates. A quality improvement project including staff training and electronic health record alerts decreased erroneous elevated blood pressure readings and increased correct hypertension diagnoses.
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