Clinical Decision Support for Hypertension Management in Chronic Kidney Disease

作者：Lipika Samal, John L. Kilgallon, Stuart R. Lipsitz, Heather J. Baer, Allison B. McCoy, Michael P. Gannon, Sarah H Noonan, R. Dunk, S. Chen, Weng Ian Chay, Richard Fay, Pamela M. Garabedian, Edward Wu, Matthew Wien, Saul Blecker, Hojjat Salmasian, Joseph V. Bonventre, Gearoid M. McMahon, David W. Bates, Sushrut S. Waikar, Jeffrey A. Linder, Adam Wright, Patricia C. Dykes · 发表于：JAMA Internal Medicine · 年份：2024 · DOI：10.1001/jamainternmed.2023.8315 · 被引用次数：32 · 研究领域：Electronic Health Records Systems、Blood Pressure and Hypertension Studies、Artificial Intelligence in Healthcare and Education

Importance: Chronic kidney disease (CKD) affects 37 million adults in the United States, and for patients with CKD, hypertension is a key risk factor for adverse outcomes, such as kidney failure, cardiovascular events, and death. Objective: To evaluate a computerized clinical decision support (CDS) system for the management of uncontrolled hypertension in patients with CKD. Design, Setting, and Participants: This multiclinic, randomized clinical trial randomized primary care practitioners (PCPs) at a primary care network, including 15 hospital-based, ambulatory, and community health center-based clinics, through a stratified, matched-pair randomization approach February 2021 to February 2022. All adult patients with a visit to a PCP in the last 2 years were eligible and those with evidence of CKD and hypertension were included. Intervention: The intervention consisted of a CDS system based on behavioral economic principles and human-centered design methods that delivered tailored, evidence-based recommendations, including initiation or titration of renin-angiotensin-aldosterone system inhibitors. The patients in the control group received usual care from PCPs with the CDS system operating in silent mode. Main Outcomes and Measures: The primary outcome was the change in mean systolic blood pressure (SBP) between baseline and 180 days compared between groups. The primary analysis was a repeated measures linear mixed model, using SBP at baseline, 90 days, and 180 days in an inte...