Matulis Rd John Charles, Greenwood Jason, Eberle Michele, Anderson Benjamin, Blair David, Chaudhry Rajeev
Division of Community Internal Medicine, Geriatrics and Palliative Care, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, United States, 1 5072845278.
Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI, United States.
JMIR Med Inform. 2025 Apr 11;13:e70752. doi: 10.2196/70752.
Improving processes regarding the management of electronic health record (EHR) requests for chronic antihypertensive medication renewals may represent an opportunity to enhance blood pressure (BP) management at the individual and population level.
This study aimed to evaluate the effectiveness of the eRx HTN Chart Check, an integrated clinical decision support tool available at the point of antihypertensive medication refill request, in facilitating enhanced provider management of chronic hypertension.
The study was conducted at two Mayo Clinic sites-Northwest Wisconsin Family Medicine and Rochester Community Internal Medicine practices-with control groups in comparable Mayo Clinic practices. The intervention integrated structured clinical data, including recent BP readings, laboratory results, and visit dates, into the electronic prescription renewal interface to facilitate prescriber decision-making regarding hypertension management. A difference-in-differences (DID) design compared pre- and postintervention hypertension control rates between the intervention and control groups. Data were collected from the Epic EHR system and analyzed using linear regression models.
The baseline BP control rates were slightly higher in intervention clinics. Postimplementation, no significant improvement in population-level hypertension control was observed (DID estimate: 0.07%, 95% CI -4.0% to 4.1%; P=.97). Of the 19,968 refill requests processed, 46% met all monitoring criteria. However, clinician approval rates remained high (90%), indicating minimal impact on prescribing behavior.
Despite successful implementation, the tool did not significantly improve hypertension control, possibly due to competing quality initiatives and high in-basket volumes. Future iterations should focus on enhanced integration with other decision support tools and strategies to improve clinician engagement and patient outcomes. Further research is needed to optimize chronic disease management through EHR-integrated decision support systems.
改进慢性抗高血压药物续方电子健康记录（EHR）请求的管理流程，可能是在个体和人群层面加强血压（BP）管理的一个契机。
本研究旨在评估电子处方高血压图表检查（eRx HTN Chart Check）的有效性，这是一种在抗高血压药物续方请求时可用的综合临床决策支持工具，用于促进医生对慢性高血压的管理。
该研究在梅奥诊所的两个地点进行——威斯康星州西北部家庭医学部和罗切斯特社区内科诊所，对照组为梅奥诊所的类似诊所。干预措施将结构化临床数据，包括近期血压读数、实验室检查结果和就诊日期，整合到电子处方续方界面，以促进开处方者在高血压管理方面的决策。采用差异中的差异（DID）设计，比较干预组和对照组干预前后的高血压控制率。数据从Epic EHR系统收集，并使用线性回归模型进行分析。
干预诊所的基线血压控制率略高。实施后，未观察到人群层面高血压控制有显著改善（DID估计值：0.07%，95%CI为-4.0%至4.1%；P = 0.97）。在处理的19968次续方请求中，46%符合所有监测标准。然而，临床医生的批准率仍然很高（90%），表明对处方行为的影响最小。
尽管成功实施，但该工具并未显著改善高血压控制，可能是由于存在相互竞争的质量改进措施和高工作量。未来的迭代应侧重于与其他决策支持工具和策略加强整合，以提高临床医生的参与度和患者治疗效果。需要进一步研究，以通过EHR集成决策支持系统优化慢性病管理。
