1. 1
Primary Care
Information Project
Primary Care Information Project
NYC Department of Health & Mental Hygiene
Technology-Driven
Intervention to Improve
Hypertension Outcomes in
Community Health Centers
Divya Suri
August 13, 2014
3. 3
Primary Care
Information Project
• Few studies have examined Clinical Decision Support Systems (CDSS)
for hypertension
• There is only one study that had focused on CDSS in Community Health
Centers (CHCs)
• CHCs provide service for more than 15 million Americans, many of
which are at risk for cardiovascular disease
• This study was conducted to compare the impact of a multicomponent
intervention (EMR + CDSS + registry linked performance feedback) vs.
EMR alone on provider adherence to care recommendations and blood
pressure controlled as defined by JNC 7
Why do this study?
4. 4
Primary Care
Information Project
• Quasi-experimental: nonrandomized, pre-post intervention
• Blood pressure measures were collected for each patient encounter for 17
months pre-intervention (June 2007 – October 2008) and 15 months post-
intervention (April 2009 – June 2010)
• The five months not included in the results (November 2008 – March
2009) – intervention adoption period
Study Design: Quasi-Experimental with Repeated Measures
5. 5
Primary Care
Information Project
• Four site federally qualified CHC – Open Door Family Medical Centers –
New York
• Provide primary care to about 40,000 patients per year
• Majority: Hispanic (73.5%)
• Sixty percent of the Hispanic population were foreign born
• Thirty-five percent had Medicaid
• Fifty-eight percent were uninsured
Study Setting and Subjects
6. 6
Primary Care
Information Project
• May 2007 – Open Door installed eClinical Works (eCW) – EMR and
practice management system
• Before intervention, hypertension control was part of the provider monthly
report card. It included 15 quality improvement measures but the
measures were not benchmarked against other providers or a targeted
outcome
• They created longitudinal data from EMRs for all adult nonobstretic
patients with a hypertension diagnosis who had at least once visit during
the study period
Study Setting
7. 7
Primary Care
Information Project
• Exclusion:
• Patients of ethnicities other than black, white, or Hispanic
• Those with more than 30 visits
• Patient visits during adoption period.
• Included: 3,636 patients – 28,263 encounters
Inclusion & Exclusion
9. 9
Primary Care
Information Project
• Study team
• Open Door leadership, providers, and staff
• Staff from Primary Care Development Corporation – non-profit organization with an
expertise in practice change and improvement
• Created a set of measurable clinical goals related to hypertension management based
on JNC 7
• Goals agreed to by clinic’s Quality Improvement Committee – used as basis for
development of intervention and set of data to extract from EMR
• Part of intervention development – quantitative and qualitative interviews with clinical
staff and leadership – established baseline for evaluating change in attitude and
informed study team about what tools the providers wanted from EMR, training, etc.
Intervention Development
10. 10
Primary Care
Information Project
• CDDS features:
• Alerts – highlighting elevated BP in red
• Template – give provider information to get from patient related to
hypertension and help documentation
• Medication adherence forms – prompt clinical support staff to ask
patients questions about medication adherence
• Order set – focused on hypertension, allowing provider access to a
single screen when ordering these tests or treatments
• Clinical reminders – prompt providers to screen for tobacco use
and/or update indicated tests
Intervention: CDSS
11. 11
Primary Care
Information Project
• Director of Performance Improvement ran quarterly reports on
performance measures consistent with main study outcomes
• Chief Medical Officer presented overall performance of each site vs. Open
Door’s target blood pressure control at regular quarterly staff meetings
• Provider level performance reports – benchmarked to predetermined
targets – were e-mailed to providers quarterly
Intervention: Individual Performance Feedback
12. 12
Primary Care
Information Project
• Chief Medical Officer conducted two 2-hour training sessions for clinical
staff
• First training: JNC 7 hypertension guidelines, clinical goals and
objectives, and baseline data
• Second training: demonstrate CDSS features and reviewed new
policies and procedure guidelines for hypertension
• Clinical support staff also received 45 minute training customized to their
roles
Intervention: Training
