Eli M. Lourie


September 2013

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Introduction: Pediatric hypertension has recently emerged as important clinical entity, however, it can be difficult to recognize due to the complicated process required to identify a child’s blood pressure reading as high. Our objective was to determine if a clinical decision support tool could improve recognition of high blood pressure readings and hypertension. Methods: We created a clinical decision support tool and inserted it into the electronic office visit in a pediatric ambulatory practice. The tool calculated, displayed and interpreted the percentiles of the patients’ current and past blood pressures; and suggested an appropriate work up. Our outcome measures were number of patients with high blood pressure readings who had repeat visits within one month and who had high blood pressure placed on their problem lists. Data from the four month pre-intervention and post-intervention periods were compared. Results: During the evaluation, there were a total of 2545 office visits; a blood pressure was taken at 1175 (46.1%) of those. The intervention tool was used in every office visit regardless of the presence of a blood pressure reading. Of a total of 1820 patients seen during the study, 100 (5.5%) had at least one high blood pressure reading. During the pre-intervention period, two patients had repeat readings within one month of the initial high blood pressure (4.0%) compared to seven post-intervention (12.7%) (p = .21). During the pre-intervention period, one patient had a problem list entry (2.0%) compared to eight post-intervention (14.5%) (p=0.052). Six patients had multiple high blood pressure readings, four of whom did not continue to get appropriate follow up and one who qualified for a diagnosis of hypertension but did not have it placed on their problem list. Discussion/Conclusions: While not significant, the tool appeared to increase awareness of high blood pressure readings. The lack of appropriate follow up of patients with high readings is troubling; however, given more time and a larger sample size, the data may show significance. Additionally, including teaching about hypertension may increase clinicians’ awareness of high readings and the need for appropriate follow up.




School of Medicine



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