Dataset Information

Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE.

ABSTRACT: Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care. Methods:During a cluster-randomized clinical trial, a national cohort worked sequentially to reduce each of three different errors, including missed elevated BP. While working on their first error during an 8-month action period, practices collected control data for a different error. Practices worked to reduce two additional errors in subsequent action periods but continued to provide sustain and maintainenance data on BP. QIC intervention included video learning sessions, transparent data, failures analysis, coaching, and tools to reduce errors. Mixed-effects logistic regression models compared the mean percentage of patients with an elevated BP with appropriate actions taken and documented. Results:We randomized 43 practices and included 30 in the final analysis. Control and intervention phases included 1,728 and 1,834 patients with an elevated BP, respectively. Comparing control versus intervention phases, the mean percentage of patients who received appropriate actions increased from 58% to 74% [risk difference (RD) 16%; 95% CI;12%, 20%]. Practices continued to improve during the sustain phase as compared to the intervention phase (RD 5%; 95% CI; 2%, 9%) and did not worsen during the maintenance phase (RD 0.9%; 95% CI -5%, 7%). Conclusions:Missed pediatric elevated BP can be sustainably reduced via a QIC intervention, demonstrating a possible model for other error reduction efforts.

SUBMITTER: Rinke ML

PROVIDER: S-EPMC6831043 | biostudies-literature | 2019 Sep-Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE.

Rinke Michael L ML Singh Hardeep H Brady Tammy M TM Heo Moonseong M Kairys Steven W SW Orringer Kelly K Dadlez Nina M NM Bundy David G DG

Pediatric quality & safety 20190930 5

Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care.<h4>Methods</h4>During a cluster-randomized clinical trial, a national cohort worked sequentially to reduce each of three different errors, including missed elevated BP. While working on their first error during an 8-month action period, practices collected con ...[more]

PMID: 31745503

Similar Datasets

Project description:BACKGROUND:In Austria only 41% of patients with treated hypertension (HTN) have their blood pressure (BP) controlled. This study investigated a strategy to improve BP control in primary care. METHODS:General practitioners (GPs) were randomized to interventional care vs. standard care and included patients with uncontrolled office BP?>?140/90?mm?Hg. In interventional care, antihypertensive therapy was up-titrated using a single pill combination (olmesartan, amlodipine and/or hydrochlorothiazde) in 4?week intervals. In standard care, physicians were encouraged to treat according to the 2013 European Society of Cardiology guidelines for the management of arterial hypertension. The primary endpoint was the proportion of patients with controlled office BP?<?140/90?mm?Hg at 6 months. The main secondary endpoint was the improvement in 24?h ambulatory BP (ABPM, Clinicaltrials.gov NCT02377661). RESULTS:Between 2015-2017, 20 GPs contributed to patient recruitment. The trial was discontinued due to slow recruitment after inclusion of 139 eligible patients, 54 of whom were included in the interventional group. A significantly larger proportion of patients in interventional vs. standard care achieved the office BP target (67%?±?26% vs. 39%?±?29%, respectively, mean difference -27.9%, 95% confidence interval CI -54.0%; -1.7%, p?=?0.038). The proportion of patients with controlled 24?h ABPM (<130/80?mm?Hg) was similar between groups (49%?±?33% vs. 40%?±?34%, respectively, mean difference -8.8%, 95% CI -40.7%; 23.1%, p?=?0.57). At baseline, pretreated patients received an average of 1.5?±?0.8 vs. 1.7?±?0.9 antihypertensive prescriptions. At 6 months, the respective BP reductions were achieved with 1.2?±?0.5 prescriptions in interventional vs. 2.0?±?1.0 in standard care (p?<?0.01). CONCLUSION:In both groups statistically and clinically significant BP reductions were observed after 6 months. In the interventional care group, a larger proportion of patients achieved the office BP target compared to standard care. The 24?h ambulatory blood pressure levels were controlled in 44% of patients at 6 months, without significant differences between groups. The respective BP reductions were achieved with a significantly lower medication burden in interventional care.

Dataset Information

Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE.

Publications

Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure