195 - Improved Compliance of Pediatric High Blood Pressure Diagnostic Guidelines

Poster Number: 195
Publication Number: 195.143

Ei E. Khin, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, United States; Bisma Arbab, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, Aberdeen, SD, United States; Kris Nicole De Guzman, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, Rochester, NY, United States; Juliana Garcia Alvarado, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El paso, TX, United States; David H. Rodriguez, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, United States; Maria Theresa Villanos, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX, United States

Background: Our primary care clinic provides services to children on US Mexico border with large Hispanic populations who have high obesity rates and significant family history of cardiovascular disease. Improper management of childhood hypertension can lead to cardiovascular morbidity and mortality.

Objective: Our aim is to improve compliance with the American Academy of Pediatrics (AAP) recommended diagnostic guidelines of hypertension to 75% by integrating them in the electronic health record (EHR).

Design/Methods: Baseline data was collected from well-child visits for patients ages 9-18 years from November to December 2020. A Fishbone diagram was created for gap analysis and intervention. Clinic staff and pediatric residents were educated with guideline lectures, hands-on training for proper blood pressure (BP) measurement methods, and reassessed with pre and post-test questions. Outcome measures included 1) BP recorded in chart 2) screening done by simplified BP table by clinic staff 3) repeat manual BP by provider 4) BP classification 5) documentation of BP classification 6) management plan and 7) follow up schedule that was embedded in well-child visits templates in EHR in January 2021. Post EHR intervention data was collected from visits that occurred in January and February 2021 and analyzed as the first and second cycle prospectively. We reviewed 30 charts randomly in each cycle and interventions were made based on Plan-Do-Study-Act (PDSA) cycles. Repeat manual BP by providers was reassessed 2 weeks apart in the post-intervention third and fourth cycle.

Results: Prior to these initiatives, there was no standard process and documentation of high blood pressure. Six out of 7 outcome measures (except repeat manual BP by provider) were successfully achieved to 86%-100% range in the second cycle post-intervention. Outcome measures of baseline data, post-intervention data were shown (Figure 1). The intervention for repeat manual BP included education to resident physicians via email, reminder notes in residents’ working station, alert to providers if there is high BP, individualized feedback from resident champions. Annotated run chart (Figure 2) demonstrates repeat manual BP by provider improved from 38% to 89%.Conclusion(s): Residents-run well-child clinics successfully improved adherence to pediatric high blood pressure guidelines. Integrating the recommended guidelines into the EHR can improve guideline compliance. Future quality improvement should be focused on younger children and the sustainability of this project.
Figure 1. Improvement of outcome measures percentages from baseline to post intervention 2 cycles
Figure 2. Percent changes in repeat manual BP by provider with interventions