Recognizing Pediatric Elevated Blood Pressure using an EPIC Best Practice Alert

Atherosclerotic cardiovascular diseases (ASCVD) such as heart attack and stroke have their roots beginning in childhood and adolescence with the inception of risk factors such as high blood pressure (hiBP). Unfortunately, data from others (Hansen et al, 2007) and your authors (Twichell et al, 2017) show hiBP is grossly under-recognized in youth, leading to the American Academy of Pediatrics (AAP) to reformulate the abnormal thresholds in September 2017 (Flynn et al, 2017).

Texas Children’s Pediatrics (TCP), the largest primary care pediatric group practice in the USA, formulated a multipart intervention to improve hiBP recognition in January 2019, one part of which was an electronic health record-based EPIC pop-up best practice alert for medical assistants and, separately, medical providers, highlighting a measured hiBP and then suggested further actions that indirectly signal provider recognition of hiBP as the key outcome of interest defined as ICD10 diagnosis, hiBP on the problem list, referral to specialist provider, or hiBP medication.

Data was compiled on all adolescents visiting TCP practices 14 months pre- intervention (n=7,444) and 14 months post-intervention (n=4,546) on these hiBP recognition indicators. This data analysis showed a 66% relative increase in hiBP recognition indicators (pre 15% vs post 25.4%, p<0.0001). Medication treatment specifically relatively increased by 67% (1.9% vs 3.1%, p=0.001). Temporal trends showed complex patterns. Therefore, the TCP hiBP intervention was associated with higher proportions of recognition and treatment, but acceptable levels are not yet being achieved.