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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1063 — Impact of Decision Support for Hypertension on Clinicians’ Prescribing and Patients’ Blood Pressures

Author List:
Goldstein MG (VA Palo Alto Health Care System Stanford Medical Informatics, Stanford, CA & Center for Primary Care and Outcomes Research, Stanford University)
Martins SB (VA Palo Alto Health Care System)
Chan AS (VA Palo Alto Health Care System & Palo Alto Medical Foundation, Palo Alto, CA)
Cloeman RW (VA Palo Alto Health Care System)
Bosworth HB (Durham VA Medical Center)
Oddone EZ (Durham VA Medical Center)
Shlipak MG (San Francisco VA Medical Center)
Harris A (VA Palo Alto Health Care System)
Lavori P (VA Palo Alto Health Care System)
Hoffman BB (Boston VA Medical Center & Harvard Medical School, Boston, MA)

Objectives:
Quantify the effect of ATHENA Decision Support System (DSS) for management of hypertension on primary care clinicians’ (PCP) prescribing when treating patients with blood pressure (BP) above target goal and on patient systolic BP (SBP) over 15 months.

Methods:
PCPs at three geographically diverse VA medical centers were randomly allocated to receive the ATHENA Hypertension Advisory window or an active control hypertension reminder window within the Computerized Patient Record System during a 15 month trial. ATHENA Hypertension Advisory displayed drug recommendations achieve target BP goals based on guideline knowledge tailored to individual patient data from the computerized medical record. Clinicians were randomized as clusters when they shared patient care. We compared clinician-clusters’ (ATHENA: 47; Control: 44) rates of intensification of antihypertensive therapy at 1st visit with a BP above target goal using a generalized estimating equation (GEE). We assessed the effects on change in SBP over 15 months using a linear mixed effects model. Analysis was by intention to treat.

Results:
34,427 visits of 11,473 patients met inclusion criteria for SBP analysis. Mean number of visits in the 15 month trial was 3.2 (sd 0.59). 9,492 patients had a BP above target during the trial and were included in the intensification of therapy analysis. Clinician-clusters receiving the ATHENA Hypertension Advisory intensified antihypertensive therapy at 1st visit with BP above target significantly more often than active control clinician clusters (OR 1.26; 95%CI 1.01,1.57). The estimated average SBP for the active control group at the end of the study was 139mmHg and the ATHENA group lowered the average SBP by 0.73 (ns).

Implications:
ATHENA DSS improved providers' prescribing for hypertensive patients by intensifying therapy when BP was above target. With a small number of visits during the trial, this did not translate to significant lowering of BP.

Impacts:
Clinical decision support systems such as ATHENA DSS may have a role in improving management of chronic illness as part of an overall guideline implementation effort that may require additional components, including more frequent return visits to adjust therapy.


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