BACKGROUND Pediatric high blood pressure (BP) predicts future cardiovascular disease events. High BP is improperly measured, underrecognized, and undermanaged especially in disadvantaged populations. In a large, diverse, academic pediatric practice, we detail the associations of a comprehensive initiative with high BP provider recognition. METHODS A comprehensive BP initiative was promulgated including (1) retraining providers and staff on BP management; (2) deploying equipment at 55+ sites; and (3) electronic decision support tool alerting staff and clinicians and suggesting management. During the 14-month preintervention and 14-month postintervention periods, data on BP and patient characteristics were collected. The outcome was incident BP recognition defined as any of the following: BP-specific International Classification of Diseases, Tenth Revision, diagnosis; problem list entry; specialty referral; diagnostic testing; repeat visit; or antihypertensives. Dichotomized as underpre versus at or over 13 years of age, analyses utilized interrupted time series and multivariable-adjusted logistic regression. RESULTS From preintervention (children, n=105 674; adolescents, n=54 365) to postintervention (children, n=87 917; adolescents, n=56 470), the proportion measured with high BP declined in children and adolescents (30% versus 14% and 30% versus 15%, respectively, each P<0.001). Post-intervention, high BP provider recognition was 58% higher in children (4.6%-7.3%) and 43% higher in adolescents (7.9% versus 11.3%; P<0.001 for both). The improvement was not different in disadvantaged race, ethnicity, or zip codes. CONCLUSIONS A comprehensive BP initiative was associated with more appropriate high BP measurement and recognition including in disadvantaged populations. Future work may address the low overall and nonsustained recognition and consideration of electronic decision support for pediatric BP management and mitigating disparities.

中文翻译：

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与电子决策支持相关的儿科高血压识别：队列分析。


背景 小儿高血压 （BP） 可预测未来的心血管疾病事件。高血压测量不当、认识不足和管理不足，尤其是在弱势群体中。在一个大型、多样化的学术儿科实践中，我们详细介绍了一项综合计划与高 BP 提供者认可的关联。方法 颁布了一项全面的 BP 倡议，包括 （1） 对提供者和工作人员进行 BP 管理再培训;（2） 在 55+ 个站点部署设备;（3） 电子决策支持工具，提醒工作人员和临床医生并提出管理建议。在干预前 14 个月和干预后 14 个月期间，收集了血压和患者特征的数据。结果是事件 BP 识别定义为以下任何一项： BP 特异性国际疾病分类，第十次修订，诊断;问题列表条目;专科转诊;诊断测试;重复访问;或抗高血压药。二分法为 underpre 与 13 岁或以上，分析使用中断时间序列和多变量调整 logistic 回归。结果 从干预前 （儿童，n=105 674;青少年，n=54 365） 到干预后 （儿童，n=87 917;青少年，n=56 470），儿童和青少年高血压测量的比例下降 （分别为 30% 对 14% 和 30% 对 15%，每个 P<0.001）。干预后，儿童高血压提供者的认可度高出 58% （4.6%-7.3%），青少年高出 43% （7.9% 对 11.3%;两者均为 P<0.001）。弱势种族、民族或邮政编码的改善没有差异。结论： 全面的 BP 计划与更适当的高血压测量和识别相关，包括在弱势群体中。 未来的工作可能会解决对儿科血压管理电子决策支持的总体和非持续认识和考虑不足的问题，并减轻差异。