title: Factors Associated With Adherence to Blood Pressure Measurement Recommendations at Pediatric Primary Care Visits, Minnesota and Colorado, 2007-2010.
abstract: BACKGROUND
  Elevated blood pressure in childhood may predict increased cardiovascular risk in young adulthood. The Task Force on the Diagnosis, Evaluation and Treatment of High Blood pressure in Children and Adolescents recommends that blood pressure be measured in children aged 3 years or older at all health care visits. Guidelines from both Bright Futures and the Expert Panel of Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents recommend annual blood pressure screening. Adherence to these guidelines is unknown.
  
  
  METHODS
  We conducted a cross-sectional study to assess compliance with blood pressure screening recommendations in 2 integrated health care delivery systems. We analyzed electronic health records of 103,693 subjects aged 3 to 17 years. Probability of blood pressure measurement documented in the electronic health record was modeled as a function of visit type (well-child vs nonwell-child); patient age, sex, race/ethnicity, and body mass index; health care use; insurance type; and type of office practice or clinic department (family practice or pediatrics).
  
  
  RESULTS
  Blood pressure was measured at 95% of well-child visits and 69% of nonwell-child outpatient visits. After adjusting for potential confounders, the percentage of nonwell-child visits with measurements increased linearly with patient age (P < .001). Overall, the proportion of children with annual blood pressure measurements was high and increased with age. Family practice clinics were more likely to adhere to blood pressure measurement guidelines compared with pediatric clinics (P < .001).
  
  
  CONCLUSIONS
  These results show good compliance with recommendations for routine blood pressure measurement in children and adolescents. Findings can inform the development of EHR-based clinical decision support tools to augment blood pressure screening and recognition of prehypertension and hypertension in pediatric patients.
authors.affiliation: HealthPartners Institute for Education and Research, Box 1524, Mail Stop 23301A, Minneapolis, MN 55440-1524. Emily.D.Parker@Healthpartners.com.
authors.forename: Emily D
authors.initials: ED
authors.lastname: Parker
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Sinaiko
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Matt F
authors.initials: MF
authors.lastname: Daley
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Elyse O
authors.initials: EO
authors.lastname: Kharbanda
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Trower
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tavel
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Sherwood
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001795:Blood Pressure Determination / Q000706:statistics & numerical data* / Q000639:trends; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D057286:Electronic Health Records; D005006:Ethnicity / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards*; D005260:Female; D006078:Government Programs; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000517:prevention & control; D019458:Insurance Coverage; D008297:Male; D008329:Managed Care Programs; D008910:Minnesota; D009819:Office Visits / Q000706:statistics & numerical data; D010372:Pediatrics / Q000592:standards*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors