实时电子病历警报可提高儿童高血压的识别率。
Real-time electronic medical record alerts increase high blood pressure recognition in children.
作者信息
Brady Tammy M, Neu Alicia M, Miller Edgar R, Appel Lawrence J, Siberry George K, Solomon Barry S
机构信息
Johns Hopkins University, Baltimore, MD, USA
Johns Hopkins University, Baltimore, MD, USA.
出版信息
Clin Pediatr (Phila). 2015 Jun;54(7):667-75. doi: 10.1177/0009922814559379. Epub 2014 Nov 20.
OBJECTIVE
Pediatric hypertension remains largely unrecognized. We hypothesized that an electronic medical record (EMR) alert would increase elevated blood pressure (BP) recognition in a pediatric primary care setting.
STUDY DESIGN
Pre-post evaluation of a real-time EMR alert and one-time provider educational session. A total of 1305 encounters of children 3 to 21 years with elevated intake BP and no prior hypertension diagnosis were included. Elevated BP recognition and relationship of recognition with cardiovascular disease (CVD) risk factors during the intervention was compared with an historical control.
RESULTS
Recognition increased from 12.5% to 42% (P < .001). Recognition increased soon after alert implementation and was sustained without evidence of "alert fatigue." During both periods, presence of CVD risk factors was associated with recognition. However, the magnitude was lesser in the intervention period.
CONCLUSIONS
Real-time EMR alerts substantially increase elevated BP recognition in children. However, underrecognition of elevated BP persisted, highlighting the need for additional strategies to improve provider recognition.
目的
儿童高血压在很大程度上仍未被识别。我们推测电子病历（EMR）警报会提高儿科初级保健机构中对血压（BP）升高的识别率。
研究设计
对实时EMR警报和一次性提供者教育课程进行前后评估。纳入了1305例3至21岁摄入血压升高且既往无高血压诊断的儿童就诊病例。将干预期间血压升高的识别率以及识别与心血管疾病（CVD）危险因素的关系与历史对照进行比较。
结果
识别率从12.5%提高到42%（P < .001）。警报实施后不久识别率就有所提高，并且持续存在，没有“警报疲劳”的迹象。在两个时期，CVD危险因素的存在都与识别有关。然而，干预期间的关联程度较小。
结论
实时EMR警报显著提高了儿童血压升高的识别率。然而，血压升高未被充分识别的情况仍然存在，这突出表明需要采取额外策略来提高提供者的识别能力。
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