Technology-driven intervention to improve hypertension outcomes in community health centers.
OBJECTIVE
To assess the impact of an electronic medical record (EMR) with clinical decision support (CDS) and performance feedback on provider adherence to guideline-recommended care and blood pressure (BP) control compared with a standard EMR alone.


METHODS
Quasi-experimental with repeated measures.


METHODS
The study was conducted in a 4-site, federally qualified health center, Open Door Family Medical Centers, located in New York. The research team, Open Door leadership, providers, and staff developed and implemented a tailored multicomponent CDS system, which included a BP alert, a hypertension (HTN) order set, an HTN template, and clinical reminders. We extracted patient-level data for each encounter 17 months prior to implementation of the intervention (June 2007-October 2008) and 15 months post-intervention (April 2009-June 2010), from the EMR's data tables for all adult nonobstetric patients with a diagnosis of HTN (N = 3636).


RESULTS
Rates of HTN control were significantly greater in the post-intervention period compared with the baseline period (50.9% vs 60.8%; P <.001). Process measures, derived from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Guidelines, also improved significantly. Logistic regression with generalized estimating equations showed that patients were 1.5 times more likely to have controlled BP post-intervention than pre-intervention. Correlates of poor BP control were black race, higher body mass index, diabetes, female gender, income, and a greater number of prescribed antihypertensive medications.


CONCLUSIONS
Our findings suggest that health information technology that is implemented as part of a multicomponent quality improvement initiative can lead to improvements in HTN care and outcomes.
Division of General Internal Medicine, New York University School of Medicine, 227 East 30th St., New York, NY 10016, USA. Donna.shelley@nyumc.org
Donna
D
Shelley
Tuo-Yen
TY
Tseng
Abigail G
AG
Matthews
Daren
D
Wu
Pamela
P
Ferrari
Asaf
A
Cohen
Mari
M
Millery
Olugbenga
O
Ogedegbe
Lindsay
L
Farrell
Helene
H
Kopal
D000704:Analysis of Variance; D001794:Blood Pressure; D003151:Community Health Centers / Q000458:organization & administration*; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical / Q000295:instrumentation* / Q000458:organization & administration; D057286:Electronic Health Records / Q000295:instrumentation* / Q000458:organization & administration; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016015:Logistic Models; D008490:Medical Informatics / Q000295:instrumentation* / Q000458:organization & administration; D036301:Qualitative Research; D013223:Statistics as Topic; D016896:Treatment Outcome; D014481:United States