Impact of computerized decision support on blood pressure management and control: a randomized controlled trial.
BACKGROUND
We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.


METHODS
We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients' race/ethnicity using interaction terms.


RESULTS
Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients' demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%, P < 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13-1.72]) and the effects of the intervention did not differ by patients' race and ethnicity.


CONCLUSIONS
CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed.
Hicks
Leroi S
LS
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA. lhicks1@partners.org
Sequist
Thomas D
TD
Ayanian
John Z
JZ
Shaykevich
Shimon
S
Fairchild
David G
DG
Orav
E John
EJ
Bates
David W
DW
D000046:Academic Medical Centers; D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003151:Community Health Centers; D020000:Decision Support Systems, Clinical; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006770:Hospitals, Group Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D044465:White People
D000959:Antihypertensive Agents