@Article{chd.12469,
AUTHOR = {Sarah A. Twichell, Corinna J. Rea, Patrice Melvin, Andrew J. Capraro, Joshua C. Mandel, Michael A. Ferguson, Daniel J. Nigrin, Kenneth D. Mandl, Dionne Graham, Justin P. Zachariah},
TITLE = {The effect of an electronic health record–based tool on abnormal pediatric blood pressure recognition},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {12},
YEAR = {2017},
NUMBER = {4},
PAGES = {484--490},
URL = {http://www.techscience.com/schd/v12n4/39176},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Recognition of high blood pressure (BP) in children is poor, partly due to the need to
compute age-sex-height referenced percentiles. This study examined the change in abnormal BP
recognition before versus after the introduction of an electronic health record (EHR) app designed
to calculate BP percentiles with a training lecture.<br/>
<b>Methods and results:</b> Clinical data were extracted on all ambulatory, non-urgent encounters
for children 3–18 years old seen in primary care, endocrinology, cardiology, or nephrology clinics at an urban, academic hospital in the year before and the year after app introduction.
Outpatients with at least 1 BP above the age-gender-height referenced 90th percentile were
included. Abnormal BP recognition was defined as a BP related ICD-9 code, referral to
nephrology or cardiology, an echocardiogram or renal ultrasound to evaluate BP concern, or a
follow-up primary care visit for BP monitoring. Multivariable adjusted logistic regression compared odds of recognition before and after app introduction. Of 78 768 clinical encounters,
3521 had abnormal BP in the pre- and 3358 in the post-app period. App use occurred in
13% of elevated BP visits. Overall, abnormal BP was recognized in 4.9% pre-app period visits
and 7.1% of visits post-app (P < .0001). Recognition was significantly higher when the app
was actually used (adjusted OR 3.17 95% CI 2.29–4.41, P < .001). Without app use recognition was not different.<br/>
<b>Conclusions:</b> BP app advent modestly increased abnormal BP recognition in the entire cohort, but
actual app use was associated with significantly higher recognition. Predictors of abnormal BP recognition deserve further scrutiny.},
DOI = {10.1111/chd.12469}
}