Journal of General Internal Medicine

, Volume 23, Issue 4, pp 429–441 | Cite as

Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial

  • LeRoi S. Hicks
  • Thomas D. Sequist
  • John Z. Ayanian
  • Shimon Shaykevich
  • David G. Fairchild
  • E. John Orav
  • David W. Bates
Original Article

Abstract

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.

MEASUREMENTS AND MAIN 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.

KEY WORDS

hypertension race and ethnicity implementation research randomized trials 

Notes

Acknowledgments

The authors would like to thank Deborah H. Williams for programming assistance. This study was supported by a grant from the Agency of Healthcare Research and Quality (#3U18 HS11046). Dr. Hicks was supported by the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program.

Conflict of Interest

None disclosed.

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • LeRoi S. Hicks
    • 1
    • 2
    • 3
  • Thomas D. Sequist
    • 1
    • 3
  • John Z. Ayanian
    • 1
    • 3
    • 6
  • Shimon Shaykevich
    • 1
  • David G. Fairchild
    • 4
  • E. John Orav
    • 1
    • 5
  • David W. Bates
    • 1
    • 6
  1. 1.Division of General Internal MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Brigham and Women’s-Faulkner Hospitalist ProgramBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  4. 4.Division of General MedicineTuft’s-New England Medical CenterBostonUSA
  5. 5.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  6. 6.Health Policy and ManagementHarvard School of Public HealthBostonUSA

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