Chapman Cole G, Polgreen Philip M, Suneja Manish, Carter Barry L, Polgreen Linnea A
Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa, USA.
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.
Am J Hypertens. 2025 Mar 17;38(4):225-232. doi: 10.1093/ajh/hpae153.
Blood pressure (BP) is routinely measured and recorded at healthcare visits, but high BP (HBP) measurements are not always discussed in clinical notes. Our objective was to identify patient- and visit-level factors associated with discussion of HBP measurements in clinical notes, among patients without prior diagnosis of hypertension.
Data from 2016 to 2022 for all patients with any BP record of 140/90 mmHg or greater were obtained from University of Iowa Hospitals and Clinics electronic medical records. Patients with any prior hypertension diagnosis were excluded. We used a multi-level regression model to evaluate differences in the rates of discussing HBP. The model included varying intercepts for visit specialty and non-varying slopes and intercepts for patient- and visit-level features.
The final sample included 278,766 outpatient visits for 27,423 patients, of which 61,739 visits had HBP. Only 31% of visits with HBP had associated clinical notes with a discussion of HBP. Even in primary-care-related clinics, HBP measurements were discussed in only 70% of visits. Factors associated with decreased odds of HBP being discussed in clinical notes included fever (OR: 0.46; 95%CI: 0.24-0.86) or external injury or pain (0.84; 0.79-0.90), and a larger number of comorbidities (6+: 0.27; 0.22-0.32). Discussion of HBP in clinical notes was more likely among visits of patients with prior visits where HBP was discussed in clinical notes (12.36; 11.75-13.01).
We found that discussion of HBP is relatively uncommon. Increasing discussion of hypertension in clinical notes could decrease hypertension-related diagnostic inertia.
在医疗就诊时，血压（BP）会常规测量并记录，但临床记录中并不总是会讨论高血压（HBP）测量结果。我们的目标是确定在未预先诊断为高血压的患者中，与临床记录中讨论HBP测量结果相关的患者和就诊层面的因素。
从爱荷华大学医院和诊所的电子病历中获取2016年至2022年所有血压记录为140/90 mmHg或更高的患者的数据。排除任何预先诊断为高血压的患者。我们使用多层次回归模型来评估讨论HBP的比率差异。该模型包括就诊专科的不同截距以及患者和就诊层面特征的不变斜率和截距。
最终样本包括27423名患者的278766次门诊就诊，其中61739次就诊有HBP。只有31%的HBP就诊有相关临床记录讨论了HBP。即使在与初级保健相关的诊所中，也只有70%的就诊讨论了HBP测量结果。与临床记录中讨论HBP可能性降低相关的因素包括发热（比值比：0.46；95%置信区间：0.24 - 0.86）或外伤或疼痛（0.84；0.79 - 0.90），以及更多的合并症（6种及以上：0.27；0.22 - 0.32）。在之前临床记录中讨论过HBP的患者就诊时，临床记录中更有可能讨论HBP（12.36；11.75 - 13.01）。
我们发现讨论HBP相对不常见。增加临床记录中对高血压的讨论可能会减少与高血压相关的诊断惰性。
