Improved Compliance of Pediatrics High Blood Pressure Guidelines in Well-Child Clinic Visits.

Abstract

Childhood hypertension can lead to cardiovascular morbidity and mortality in young adult life. We aim to improve compliance with the American Academy of Pediatrics recommended blood pressure (BP) guideline steps to 75% over 12 months in children 9 to 18 years old during well-child visits.

Methods: The providers were educated on American Academy of Pediatrics high BP clinical practice guidelines. We integrated the guideline steps into the electronic medical record (EMR) and analyzed outcome measures. The outcome measures were: (1) BP recorded in the chart, (2) screening done by simplified BP table by clinic staff, (3) repeat manual BP by the provider, (4) BP classification, (5) documentation of BP classification, (6) management plan, and (7) follow-up schedule. Specific interventions were made based on each plan-do-study-act (PDSA) cycle, including reeducating the guidelines, reemphasizing following the EMR steps, and providing providers with individualized feedback and alerts.

Results: Six of 7 outcome measures (except repeat manual BP by provider) achieved 86%-100% range after the second PDSA cycle. The annotated run chart demonstrates that repeat manual BP by provider improved from 38% to 89% in the fourth PDSA cycle.

Conclusion: Pediatric residents who run well-child clinics improved adherence to pediatric high BP guidelines by providing education and integrating prompts and information into the EMR.