HealthPartners Institute (SP Dehmer, NK Trower, SE Asche, HL Ekstrom, JD Nordin, PJ O'Connor, and EO Kharbanda), Minneapolis, Minn.
Department of Pediatrics, University of Minnesota (AR Sinaiko), Minneapolis, Minn.
Acad Pediatr. 2020 Aug;20(6):848-856. doi: 10.1016/j.acap.2020.01.011. Epub 2020 Jan 28.
To evaluate economic costs from the health system perspective of an electronic health record-based clinical decision support (CDS) tool, TeenBP, designed to assist in the recognition and management of hypertension in youth.
Twenty primary care clinics within an integrated health system were randomized to the TeenBP CDS or usual care (UC), with patient enrollment from 4/15/14 to 4/14/16. The 12-month change in standardized medical care costs for insured patients aged 10 to 17 years without prior hypertension were calculated for each study arm. The primary analysis compared patients with ≥1 visit with blood pressure (BP) ≥95th percentile (isolated hypertensive BP), and secondary analyses compared patients with ≥3 visits within one year with BP ≥95th percentile (incident hypertension). Generalized estimating equation models estimated the difference-in-differences in costs between groups over time.
Among 925 insured patients with an isolated hypertensive BP, the pre-to-post change in overall costs averaged $22 more for TeenBP CDS versus UC patients over 12 months, but this difference was not statistically significant (P = .723). Among 159 insured patients with incident hypertension, the pre-to-post change in overall costs over 12 months was higher by $227 per person on average for TeenBP CDS versus UC patients, but this difference also was not statistically significant (P = .313).
The TeenBP CDS intervention was previously found to significantly improve identification and management of hypertensive BP in youth, and in this study, we find that this tool did not significantly increase care costs in its first 12 months of clinical use.
从健康系统的角度评估基于电子健康记录的临床决策支持 (CDS) 工具 TeenBP 的经济成本，该工具旨在帮助识别和管理青少年高血压。
在一个综合健康系统内的 20 个初级保健诊所被随机分配到 TeenBP CDS 或常规护理 (UC)，患者招募时间为 2014 年 4 月 15 日至 2016 年 4 月 14 日。计算了每个研究臂中无既往高血压的 10 至 17 岁有保险的患者在 12 个月内标准化医疗费用的变化。主要分析比较了有≥1 次血压 (BP) ≥95 百分位数 (孤立性高血压 BP) 的患者，次要分析比较了在一年内有≥3 次 BP ≥95 百分位数 (新发高血压) 的患者。广义估计方程模型估计了两组随时间的成本差异。
在 925 名有孤立性高血压 BP 的有保险患者中，在 12 个月内，与 UC 患者相比，TeenBP CDS 的总体费用增加了 22 美元，但差异无统计学意义 (P=0.723)。在 159 名有新发高血压的有保险患者中，在 12 个月内，与 UC 患者相比，TeenBP CDS 的总体费用增加了 227 美元，但差异也无统计学意义 (P=0.313)。
先前的研究发现，TeenBP CDS 干预显著改善了青少年高血压的识别和管理，在本研究中，我们发现该工具在其临床应用的前 12 个月内并未显著增加护理成本。
