Impact of Computerized Decision Support on Racial/Ethnic Disparities in Hypertension Outcomes

In response to the Finding Answers: Disparities Research for Change call for proposals by
the Robert Wood Johnson Foundation, we were funded to evaluate the effectiveness of a
planned computerized decision support (CDS) intervention aimed at medical providers to
overcome clinical inertia when treating blood pressure for hypertensive patients. Based on
prior evaluation of the Brigham and Women's Hospital (BWH) adult primary care clinics, we
hypothesize that racial and ethnic differences in blood pressure outcomes are largely
attributable in differences in providers' aggressiveness in managing patients with
hypertension based on patients' race and ethnicity. Within our network of 14 hospital and
community-based Brigham and Women's Hospital adult primary care clinics, we aim to determine
if the use of CDS to remind to medical providers of poorly controlled hypertensive patients
to intensify their hypertension therapy will improve overall rates of blood pressure control
and reduce the previously documented racial and ethnic disparities in blood pressure
outcomes among our hypertensive patient population. Clinics will first be stratified by
location (hospital-based versus community-based) and within each strata will be randomized
to either have their providers receive CDS for hypertensive patients whose most recent blood
pressure was uncontrolled or to usual care for hypertensive patients. More specifically, we
will evaluate our planned intervention by utilizing an 18 month cluster-randomized
controlled trial to examine the effectiveness the CDS for intensification of hypertension
therapy in: improving levels of blood pressure control, improving provider adherence with
recommended changes in drug therapy, and reducing racial/ethnic disparities in the processes
of hypertension care and outcomes among our patients receiving primary care for a diagnosis
of hypertension.