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Tas V, Birisci E, Jones RA, Forbus JJ, Blaszak RT, Crawford B, Ilyas M, Magee JS, Sisterhen LL. Improving Pediatric Hypertension Screening in an Academic Primary Care Setting. Pediatr Qual Saf 2024; 9:e746. [PMID: 38993274 PMCID: PMC11236397 DOI: 10.1097/pq9.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Adherence to the American Academy of Pediatrics clinical practice guidelines for screening and managing high blood pressure (BP) is low. This team sought to improve recognition and documentation of relevant diagnoses in patients aged 13-20 years who presented to general pediatric clinics. Methods The primary outcome measure was the proportion of office visits for patients ages 13-20 with a BP ≥ 120/80 with a visit or problem list diagnosis of hypertension or elevated BP. Secondary measures included (1) the proportion of patients who had their BP measured in the right arm, (2) the proportion of patients who had a mid-arm circumference measurement recorded, and (3) the proportion of patients who had a second BP reading measured at the visit. Interventions addressed key drivers for evidence-based high BP screening: standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption. Data were collected over a twenty-seven-month period and plotted using the Laney p' chart. Results Provider documentation of elevated BP or hypertension improved from a baseline mean of 24% in April 2020 through January 2022 to 41% in February 2021 through June 2022. All secondary outcome measures also demonstrated significant improvement. Conclusions This project demonstrates the feasibility of improving adherence to best practices of BP measurement in primary care clinics through education, acquisition of resources, and implementation of electronic health record flags for abnormal values.
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Affiliation(s)
- Vildan Tas
- From the Department of Pediatrics, University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Little Rock, Penn
| | - Esma Birisci
- Department of Econometrics, Bursa Uludağ University, Bursa, Turkey
| | - Rachel Achor Jones
- Process Improvement and Population Health Departments, Arkansas Children's Hospital, Little Rock, Ark
| | - John J Forbus
- Process Improvement and Population Health Departments, Arkansas Children's Hospital, Little Rock, Ark
| | - Richard T Blaszak
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Brendan Crawford
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Mohammad Ilyas
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - James S Magee
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Laura L Sisterhen
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
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Hamoen M, Welten M, Nieboer D, Bai G, Heymans MW, Twisk JWR, Raat H, Vergouwe Y, Wijga AH, de Kroon MLA. Development of a prediction model to target screening for high blood pressure in children. Prev Med 2020; 132:105997. [PMID: 31981642 DOI: 10.1016/j.ypmed.2020.105997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
Targeted screening for childhood high blood pressure may be more feasible than routine blood pressure measurement in all children to avoid unnecessary harms, overdiagnosis or costs. Targeting maybe based e.g. on being overweight, but information on other predictors may also be useful. Therefore, we aimed to develop a multivariable diagnostic prediction model to select children aged 9-10 years for blood pressure measurement. Data from 5359 children in a population-based prospective cohort study were used. High blood pressure was defined as systolic or diastolic blood pressure ≥ 95th percentile for gender, age, and height. Logistic regression with backward selection was used to identify the strongest predictors related to pregnancy, child, and parent characteristics. Internal validation was performed using bootstrapping. 227 children (4.2%) had high blood pressure. The diagnostic model included maternal hypertensive disease during pregnancy, maternal BMI, maternal educational level, parental hypertension, parental smoking, child birth weight standard deviation score (SDS), child BMI SDS, and child ethnicity. The area under the ROC curve was 0.73, compared to 0.65 when using only child overweight. Using the model and a cut-off of 5% for predicted risk, sensitivity and specificity were 59% and 76%; using child overweight only, sensitivity and specificity were 47% and 84%. In conclusion, our diagnostic prediction model uses easily obtainable information to identify children at increased risk of high blood pressure, offering an opportunity for targeted screening. This model enables to detect a higher proportion of children with high blood pressure than a strategy based on child overweight only.
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Affiliation(s)
- Marleen Hamoen
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands; Erasmus MC, University Medical Center Rotterdam, The Generation R Study Group, Rotterdam, Netherlands
| | - Marieke Welten
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, Netherlands
| | - Daan Nieboer
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Guannan Bai
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, Netherlands
| | - Hein Raat
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Yvonne Vergouwe
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Alet H Wijga
- National Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Bilthoven, Netherlands
| | - Marlou L A de Kroon
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands; Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands.
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Epure AM, Chiolero A. From detection early in life to the primordial prevention of elevated blood pressure. J Clin Hypertens (Greenwich) 2019; 21:1350-1351. [PMID: 31381245 DOI: 10.1111/jch.13634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adina Mihaela Epure
- Department of Epidemiology and Health Services, Center for Primary Care and Public Health (UNISANTÉ), University of Lausanne, Lausanne, Switzerland
| | - Arnaud Chiolero
- Department of Epidemiology and Health Services, Center for Primary Care and Public Health (UNISANTÉ), University of Lausanne, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
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