Department of Internal Medicine, Henry Ford Hospital and Wayne State University, Detroit, Michigan, USA.
Department of Emergency Medicine, Henry Ford Hospital and Wayne State University, Detroit, Michigan, USA.
Am J Hypertens. 2021 Oct 27;34(10):1078-1082. doi: 10.1093/ajh/hpab081.
Primary care management of hypertension under new guidelines incorporates assessment of cardiovascular disease risk and commonly requires review of electronic health record (EHR) data. Visual analytics can streamline the review of complex data and may lessen the burden clinicians face using the EHR. This study sought to assess the utility of a visual analytics dashboard in addition to EHR in managing hypertension in a primary care setting.
Primary care physicians within an urban, academic internal medicine clinic were tasked with performing 2 simulated patient encounters for hypertension management: the first using standard EHR, and the second using EHR paired with a visual dashboard. The dashboard included graphical blood pressure trends with guideline-directed targets, calculated atherosclerotic cardiovascular disease risk score, and relevant medications. Guideline-appropriate antihypertensive prescribing, correct target blood pressure goal, and total encounter time were assessed.
We evaluated 70 case simulations. Use of the dashboard with the EHR compared with use of the EHR alone was associated with greater adherence to prescribing guidelines (95% vs. 62%, P < 0.001) and more correct identification of blood pressure target (95% vs. 57%, P < 0.01). Total encounter time fell an average of 121 seconds (95% confidence interval 69-157 seconds, P < 0.001) in encounters that used the dashboard combined with the EHR.
The integration of a hypertension-specific visual analytics dashboard with EHR demonstrates the potential to reduce time and improve hypertension guideline implementation. Further widespread testing in clinical practice is warranted.
根据新指南，初级保健管理高血压需要评估心血管疾病风险，通常需要查看电子健康记录 (EHR) 数据。可视化分析可以简化对复杂数据的审查，并可能减轻临床医生使用 EHR 面临的负担。本研究旨在评估在初级保健环境中管理高血压时，可视化分析仪表板除了 EHR 之外的实用性。
城市学术内科诊所的初级保健医生负责进行 2 次模拟高血压管理患者就诊：第一次使用标准 EHR，第二次使用 EHR 与可视化仪表板配对。仪表板包括图形血压趋势和指南导向的目标、计算出的动脉粥样硬化性心血管疾病风险评分以及相关药物。评估了指南适当的抗高血压药物处方、正确的目标血压目标和总就诊时间。
我们评估了 70 个病例模拟。与单独使用 EHR 相比，使用 EHR 与仪表板结合使用与更高的处方指南依从性相关（95%对 62%，P < 0.001），并且更正确地确定了血压目标（95%对 57%，P < 0.01）。在使用仪表板结合 EHR 的就诊中，平均就诊时间减少了 121 秒（95%置信区间为 69-157 秒，P < 0.001）。
将特定于高血压的可视化分析仪表板与 EHR 集成显示了减少时间和提高高血压指南实施的潜力。需要在临床实践中进一步广泛测试。
