Online Program

Undiagnosed Hypertension Management: The Effect of Clinical Decision Support in Community Health Centers

Tuesday, November 3, 2015

Jessica Park, MPH, Alliance of Chicago Community Health Services, Chicago, IL
Fred Rachman, MD, Alliance of Chicago Community Health Services, Chicago, IL
Study Design/Methods

Based on an evidence-based algorithm, Alliance staff built Adult Blood Pressure Management CDS content, including identification triggers when the patient is at risk but has not yet been diagnosed with hypertension. The tool was implemented in over 150 Alliance health delivery sites and usability was tracked through weekly reports. Reporting tools were also created, giving CHC staff the ability to generate lists of patients who meet the algorithm, have not been diagnosed with hypertension, their contact information, and follow-up appointment information.  CHC staff were trained on the tool and was able to share best practices and suggested changes. 

Principal Findings and Quantitative/Qualitative Results

Preliminary reports show a slow uptake  in use of the tool at CHCs. Discussion with CHCs revealed that many did not have any formal training on the forms and were not aware of the its existence. Those who were aware of the form had not yet figured out how to fit the form into their workflows and the priorities currently for CHCs revolve around Meaningful Use, Patient Centered Medical Home, and other federally required initiatives. The integration of one CDS tool among more than 30 different entities proved to be a complicated task, both technically and programmatically.

Conclusions/Impact on Health Centers

Undiagnosed hypertension continues to be a significant issue and of high priority in CHCs. The Adult Blood Pressure Management CDS tool created for this project can serve as a prototype for other EMR vendor systems to be broadly replicated beyond the participants of this project. CDS tools have proven to be effective in improving care, however due to competing priorities and workforce burden, more effort and resources are needed to fully optimize these tools in health center workflow. Leadership involvement and championing can also be an effective catalyst for change.

Learning Areas:

Chronic disease management and prevention
Communication and informatics

Learning Objectives:
Assess the quality of hypertension health care for low income and underserved populations Design and develop a comprehensive standardized undiagnosed hypertension electronic medical record (EMR) tool that incorporates an evidence-based algorithm Discuss best practices and barriers to EMR optimization through CDS tools

Keyword(s): Hypertension, Information Technology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the coordinator of the funded project that I am a presenter for. For the past three years, I have experienced working with other federally and privately funded projects that center around clinical decision support in community health centers. I provide support and coordination for 33 health centers across 15 states in the Alliance of Chicago network.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.