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Resident PGY 1
Henry Ford Hospital
Background: Primary care management of essential hypertension (HTN) has become increasingly challenging since recently published guidelines integrate atherosclerotic cardiovascular disease (ASCVD) risk stratification into decision making. Our objective was to measure whether overlay of visualdecision support (VDS) with standard electronic health record (EHR) platform improves guideline-based treatment, and reduces time burden associated with EHR use, in management of essential HTN. Methods: This was a quality improvement project. We interviewed primary care physicians and tasked each with two simulated patient encounters for HTN: (1) using standard EHR to guide treatment, and (2) using VDS to guide treatment. The VDS included graphical blood pressure (BP) trends, target BP with recommended interventions, ASCVD risk score, and information on the patient’s social determinants of health. We assessed whether treatment selection was congruent with guidelines and tracked time physicians consulted the EHR. Results: We evaluated 70 case simulations in total. Use of VDS compared to usual EHR was associated with: higher proportion of correct guideline prescribing (94% vs. 60%, p<0.01), more ASCVD risk determination (100% vs. 23, p<0.01), and more correct BP target identification (97% vs. 60%, p<0.01). Time clinicians spent consulting the EHR fell an average of 121 seconds with use of VDS (p<0.01). On a 10-point scale, clinicians rated the VDS 9.2 vs. 5.9 (p<0.01) for ease of gathering necessary information to treat HTN. Conclusions: The integration video decision support tools to standard EHR can reduce physician time spent per patient encounter, while increasing adherence to guidelines and improving patient outcomes. Further testing in clinical practice is indicated.
Fadel, Raef; Miller, Joseph B. MD; Ibrahim, Hanan; Hammoudeh, Rawan; Ahluwalia, Guneet; Roumayah, Tamara; Scott, Megan; Gandhi, Nitesh; France, John; Theoharis, Thomas; and Ross, Jacob, "EHR Visual Overlay Promises to Improve Hypertension Guideline Implementation" (2019). Quality Improvement. 7.