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Developing Electronic Clinical Reminders for Improving Hypertension Management: The Approach of the Department of Veterans Affairs

Glassman PA, Volpp B, Walder D, Craig T, Berlowitz D, Kressin N, Furmaga E, Lopez J, Rothendler J, Schoonover D, Siegel D, Steele P. Developing Electronic Clinical Reminders for Improving Hypertension Management: The Approach of the Department of Veterans Affairs. The Journal on Information Technology in Healthcare. 2003 Oct 1; 1(4):251-265.

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Objective: Recent evidence suggests that less then one-third of hypertensive patients in the United States have adequate blood pressure control. In an attempt to improve hypertension management for Department of Veterans Affairs' (VA) patients, we implemented three electronic hypertension reminders using the VA's Computerized Patient Record System. This paper describes the design processes and presents pilot results from one of the three test sites.Design: We developed two blood pressure control reminders: one for patients with blood pressures 140/90 mmHg to 159/99 mmHg and one for patients with blood pressures 160/100 mmHg and higher. In patients who had an International Classification of Diseases (ICD) code for hypertension (usually 401.9), systolic or diastolic blood pressures above thresholds triggered the particular reminder.Methods: Net and phone conferencing were used to achieve consensus about design, format and content of reminders among team members. Three voluntary sites loaded and tested the reminders at various stages of development, in order to assess usability and to better inform the design. Final reminders were packaged into a national patch for transfer to VA facilities in January 2003.Results: :Pilot testing at one site, over one month, found that of patients whose blood pressure reminders were resolved, 390 reportedly had their medication adjusted while 351 did rot require adjustment due to prior adequate control and 48 patients refused adjustment. Lifestyle modifications were recommended for 132 people while 156 patients reportedly exercised adequately and 133 already adhered to a heat-healthy diet.Conclusion: Electronic clinical reminders for hypertension may provide important information on provider actions for VA patients. Whether such reminders impact blood on pressure control over time remains to be assessed.

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