VISN Collaborative for Improving Hypertension Management With ATHENA-HTN

NCT00374452 | Completed Results

• 1 other identifier: IMV 04-062
• Study Type: interventional
• Target: 103
• Locations: 1 country
• Sites: 7

Brief Summary

This project is a VA HSR\&D-funded Quality Enhancement Research Initiative (QUERI) project to translate into practice evidence about clinical management of primary hypertension. The project aims to contribute to quality improvement of care for patients with primary hypertension. The project implemented a clinical decision support (CDS) system for primary care clinicians and evaluated the implementation by studying the following: impact on the clinicians' prescribing and their patients' blood pressures; the clinician satisfaction with the CDS; and organizational factors in the implementation.

Conditions

Hypertension

Keywords

hypertension; practice guidelines; quality of health care; decision support systems; evidence-based medicine; medical informatics

Outcome Measures

Primary Outcomes (1)

• Mean Percentages of Events After Index Visit to Primary Care by Patient

  The outcome measure was mean percentages of Events after index visit to primary care by patients. The Events were the first event in the patient record after the index clinic visit for the patient, as follows. Event 1 is intensification of pharmacotherapy for hypertension. Event 2 is patient achieves below-target blood pressure (BP). Event 3 is patient does not achieve below-target BP nor is there intensification of pharmacotherapy for hypertension. Event 4 is patient does not achieve BP target, does not have intensified pharmacotherapy, and does not return for further BP measurements. Each patient was assigned one and only one Event. If a patient has pharmacotherapy intensified and also achieved BP below-target, the patient was assigned to whichever happened first. An initial model fitting all 4 events did not detect a difference by study arm for mean percentage of Event 4; final findings are based on a denominator of Events 1 - 3.

  up to one year after index visit

Study Arms (2)

ATHENA-CDS-HTN plus Guideline Link

EXPERIMENTAL

ATHENA-CDS-HTN plus Guideline Link. ATHENA-CDS-HTN display on the cover sheet of electronic health record, plus link to the guidelines

Other: ATHENA-CDS-HTN plus Guideline Link

Guideline Link Only

OTHER

Guideline Link Only. Link to The Seventh Report of the Joint National Committee on Prevention Detection and Treatment of High Blood Pressure (JNC7) and to VA-Department of Defense (DoD) hypertension guidelines

Other: Guideline Link Only

Interventions

ATHENA-CDS-HTN plus Guideline Link OTHER

ATHENA display provides guideline-based recommendations to clinicians at the time of patient care.

ATHENA-CDS-HTN plus Guideline Link

Guideline Link Only OTHER

Primary care providers were sent, once, a link (URL) to the VA/DoD and JNC7 hypertension guidelines.

Guideline Link Only

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Must be primary care clinicians (for example, physician or nurse practitioner) at one of the participating VA medical centers. This study is NOT recruiting patients.
• The primary care clinician must have a panel of patients for whom he or she provides direct care.

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (7)

VA Palo Alto Health Care System

Palo Alto, California, 94304, United States

Location

VA Connecticut Health Care System (Newington)

Newington, Connecticut, 06111, United States

Location

VA Connecticut Health Care System (West Haven)

West Haven, Connecticut, 06516, United States

Location

Edith Nourse Rogers Memorial Veterans Hospital, Bedford

Bedford, Massachusetts, 01730, United States

Location

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Boston, Massachusetts, 02130, United States

Location

VA Medical Center, Manchester

Manchester, New Hampshire, 03104, United States

Location

VA Medical Center, Providence

Providence, Rhode Island, 02908, United States

Location

Related Publications (8)

• Martins SB, Lai S, Tu S, Shankar R, Hastings SN, Hoffman BB, Dipilla N, Goldstein MK. Offline testing of the ATHENA Hypertension decision support system knowledge base to improve the accuracy of recommendations. AMIA Annu Symp Proc. 2006;2006:539-43.

  PMID: 17238399 RESULT

• Chan AS, Shankar RD, Coleman RW, Matins SB, Hoffman BB, Goldstein MK. Leveraging point-of-care clinician feedback to study barriers to guideline adherence. AMIA Annu Symp Proc. 2005;2005:915.

  PMID: 16779202 RESULT

• Trafton J, Martins S, Michel M, Lewis E, Wang D, Combs A, Scates N, Tu S, Goldstein MK. Evaluation of the acceptability and usability of a decision support system to encourage safe and effective use of opioid therapy for chronic, noncancer pain by primary care providers. Pain Med. 2010 Apr;11(4):575-85. doi: 10.1111/j.1526-4637.2010.00818.x. Epub 2010 Mar 1.

  PMID: 20202142 RESULT

• Michel M, Trafton J, Martins S, Wang D, Tu S, Johnson N, Goldstein MK. Improving Patient Safety Using ATHENA-Decision Support System Technology: The Opioid Therapy for Chronic Pain Experience. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 4: Technology and Medication Safety). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug. Available from http://www.ncbi.nlm.nih.gov/books/NBK43756/

  PMID: 21249951 RESULT

• Bosworth HB, Olsen MK, Dudley T, Orr M, Goldstein MK, Datta SK, McCant F, Gentry P, Simel DL, Oddone EZ. Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial. Am Heart J. 2009 Mar;157(3):450-6. doi: 10.1016/j.ahj.2008.11.003. Epub 2009 Jan 10.

  PMID: 19249414 RESULT

• Goldstein MK. Using health information technology to improve hypertension management. Curr Hypertens Rep. 2008 Jun;10(3):201-7. doi: 10.1007/s11906-008-0038-6.

  PMID: 18765090 RESULT

• Cucciare MA, Ketroser N, Wilbourne P, Midboe AM, Cronkite R, Berg-Smith SM, Chardos J. Teaching motivational interviewing to primary care staff in the Veterans Health Administration. J Gen Intern Med. 2012 Aug;27(8):953-61. doi: 10.1007/s11606-012-2016-6. Epub 2012 Feb 28.

  PMID: 22370769 RESULT

• Steinman MA, Goldstein MK. When tight blood pressure control is not for everyone: a new model for performance measurement in hypertension. Jt Comm J Qual Patient Saf. 2010 Apr;36(4):164-72. doi: 10.1016/s1553-7250(10)36028-4.

  PMID: 20402373 RESULT

MeSH Terms

Conditions

Hypertension

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases

Limitations and Caveats

The study has originally planned to include 5 large medical centers. One of the medical centers dropped out before the intervention started. This lowered the number of clinic sites and of participants (clinicians).

Results Point of Contact

• Title: Mary K. Goldstein, MD
• Organization: VA Palo Alto Health Care System

mary.goldstein@va.gov

650-493-5000

Study Officials

• Mary K. Goldstein, MD MS

  VA Palo Alto Health Care System

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 8, 2006
• First Posted: September 11, 2006
• Study Start: January 1, 2007
• Primary Completion: May 1, 2010
• Study Completion: March 1, 2011
• Last Updated: March 29, 2018
• Results First Posted: December 18, 2017

Record last verified: 2018-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (7)