Daniel R Beacher1, Sheila Z Chang2, Joshua S Rosen3, Genna S Lipkin4, Megan M McCarville5, Maheen Quadri-Sheriff5, Soyang Kwon6, Jerome C Lane5, Helen J Binns7, Adolfo J Ariza8. 1. University of Minnesota Medical School, Minneapolis, MN; Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL. 2. University of Illinois College of Medicine at Chicago, Chicago, IL. 3. Northwestern University, Evanston, IL. 4. Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 5. Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. 6. Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL. 7. Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL; Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. 8. Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL; Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: aariza@luriechildrens.org.
Abstract
OBJECTIVE: To assess the prevalence of elevated blood pressure (BP) and its identification among outpatients at a pediatric tertiary care hospital and to assess clinician attitudes towards BP management. STUDY DESIGN: A retrospective review was undertaken of electronic medical record data of visits over the course of 1 year to 10 subspecialty divisions and 3 primary care services at an urban tertiary care hospital. Interviews of division/service representatives and a clinician survey on perceived role on BP care, practices, and protocols related to BP management were conducted. Elevated BP was defined as ≥90th percentile (using US references); identification of elevated BP was defined as the presence of appropriate codes in the problem list or visit diagnoses. RESULTS: Among 29,000 patients (ages 2-17 years), 70% (those with ≥1 BP measurement) were analyzed. Patients were as follows: 50% male; 42% white, 31% Hispanic, 16% black, 5% Asian, and 5% other/missing; 52% had Medicaid insurance. A total of 64% had normal BPs, 33% had 1-2 elevated BP measurements, and 3% had ≥3 elevated BP measurements. Among those with ≥3 elevated BP measurements, the median frequency of identification by division/service was 17%; the greatest identification was for Kidney Diseases (67%), Wellness & Weight Management (60%), and Cardiology (33%). Among patients with ≥3 elevated BP measurements, 21% were identified vs 7% identified among those with 1-2 increased measurements (P<.001). All clinician survey respondents perceived self-responsibility for identification of elevated BP, but opinions varied for their role in the management of elevated BP. CONCLUSIONS: The identification of patients with elevated BP measurements was low. Strategies to increase the identification of elevated BPs in outpatient tertiary care settings are needed.
OBJECTIVE: To assess the prevalence of elevated blood pressure (BP) and its identification among outpatients at a pediatric tertiary care hospital and to assess clinician attitudes towards BP management. STUDY DESIGN: A retrospective review was undertaken of electronic medical record data of visits over the course of 1 year to 10 subspecialty divisions and 3 primary care services at an urban tertiary care hospital. Interviews of division/service representatives and a clinician survey on perceived role on BP care, practices, and protocols related to BP management were conducted. Elevated BP was defined as ≥90th percentile (using US references); identification of elevated BP was defined as the presence of appropriate codes in the problem list or visit diagnoses. RESULTS: Among 29,000 patients (ages 2-17 years), 70% (those with ≥1 BP measurement) were analyzed. Patients were as follows: 50% male; 42% white, 31% Hispanic, 16% black, 5% Asian, and 5% other/missing; 52% had Medicaid insurance. A total of 64% had normal BPs, 33% had 1-2 elevated BP measurements, and 3% had ≥3 elevated BP measurements. Among those with ≥3 elevated BP measurements, the median frequency of identification by division/service was 17%; the greatest identification was for Kidney Diseases (67%), Wellness & Weight Management (60%), and Cardiology (33%). Among patients with ≥3 elevated BP measurements, 21% were identified vs 7% identified among those with 1-2 increased measurements (P<.001). All clinician survey respondents perceived self-responsibility for identification of elevated BP, but opinions varied for their role in the management of elevated BP. CONCLUSIONS: The identification of patients with elevated BP measurements was low. Strategies to increase the identification of elevated BPs in outpatient tertiary care settings are needed.
Authors: Elyse Olshen Kharbanda; Stephen E Asche; Alan Sinaiko; James D Nordin; Heidi L Ekstrom; Patricia Fontaine; Steven P Dehmer; Nancy E Sherwood; Patrick J O'Connor Journal: Acad Pediatr Date: 2017-07-16 Impact factor: 3.107
Authors: Elyse O Kharbanda; Steve E Asche; Alan R Sinaiko; Heidi L Ekstrom; James D Nordin; Nancy E Sherwood; Patricia L Fontaine; Steven P Dehmer; Deepika Appana; Patrick O'Connor Journal: Pediatrics Date: 2018-02 Impact factor: 7.124
Authors: Lama Ghazi; Tanja Dudenbostel; Daisy Xing; Deborah Ejem; Anne Turner-Henson; Cynthia Irwin Joiner; Olivia Affuso; Andres Azuero; Suzanne Oparil; David A Calhoun; Marti Rice; Fadi G Hage Journal: J Am Soc Hypertens Date: 2016-12-24