Clinical decision support tool improves pediatric hypertension recognition in rural clinics

This randomized controlled trial evaluated a clinical decision support (CDS) tool for pediatric hypertension within a primarily rural health system comprising 40 primary care clinics. The study enrolled 9,155 patients aged 6-17 years with elevated blood pressure measured during a primary care visit between August 1, 2022, and January 31, 2024. The intervention compared high-intensity implementation (in-person and online training, monthly check-ins, and feedback) versus low-intensity implementation (online training only) against usual care.

The primary outcome was the remeasurement of elevated blood pressure during a visit and recognition of hypertension within six months of meeting diagnostic criteria. For remeasurement, the high-intensity CDS group achieved 51.5%, the low-intensity group 23.6%, and usual care clinics 6.2%. The adjusted odds ratio for high/low-intensity versus usual care was 8.70 (95% CI 5.68-13.3), and for high-intensity versus low-intensity, it was 3.45 (95% CI 1.88-6.33).

For hypertension recognition within six months, rates were 42.8% in the high-intensity group, 24.5% in the low-intensity group, and 14.4% in usual care. The adjusted odds ratio for high/low-intensity versus usual care was 2.94 (95% CI 1.00-8.60), and for high-intensity versus low-intensity, it was 2.31 (95% CI 1.08-4.98). These results indicate that CDS tools, particularly with high-intensity implementation, substantially improve pediatric hypertension care processes in rural settings.

Safety data were not reported, including adverse events, serious adverse events, discontinuations, or tolerability. The study did not assess long-term clinical outcomes such as cardiovascular events. The cluster randomized design may introduce bias, and follow-up duration for outcomes was not clearly defined. The findings are limited to a rural health system and may not generalize to urban settings.

The practice relevance is significant: CDS tools can enhance pediatric BP care in rural clinics, with effectiveness varying by implementation intensity. As an randomized controlled trial, causality can be inferred for the intervention effects. Results are based on adjusted analyses with confidence intervals, but certainty is moderate due to the cluster design and limited follow-up details.

Clinicians should consider implementing high-intensity CDS strategies to improve hypertension recognition in pediatric patients. However, they should not infer that CDS reduces long-term hypertension complications or generalize findings to non-rural settings without further evidence. The study underscores the importance of implementation approach in achieving clinical improvements.