Boosting Primary Care Awareness and Treatment of Childhood Hypertension

Pediatric HTN causes appreciable morbidity in pediatric patients and errors in diagnosis and
management are frequent and understudied, jeopardizing pediatric safety in ambulatory
settings. Additionally, the gap between the number of pediatric subspecialist providers and
the number needed for patient care continues to widen, and it is unclear how to best reduce
burden on subspecialists, improve PCP and subspecialist communication, and improve patient
outcomes. This research team, with significant experience researching ambulatory pediatric
safety, conducting QICs and HTN interventions, identified six large pediatric practice groups
in rural, suburban and urban locations that are committed to reducing preventable HTN patient
harm, to testing the effectiveness of a QIC to improve PCP HTN diagnosis and management, and
to a hub and spoke HTN co-diagnosis and co-management model. The effect demonstrated by this
project using a rigorous research design and the new 2017 pediatric HTN guidelines, will
motivate pediatric clinics across the country to adopt these newly-identified best practices
to improve pediatric HTN care. Primary care pediatricians have an imperative to diagnose and
manage HTN and elevated BP (EBP) more accurately and earlier, and to improve interactions
with subspecialists to reduce the lifelong preventable harm that results from these chronic
conditions. This proposal, will identify a clear implementation strategy for rigorous,
evidenced-based pediatric HTN diagnosis and management, and highlight a model to increase
primary and subspecialty care integration that can be reproduced across other chronic
conditions.

The primary human subjects of this work are the physicians and staff within the primary care
pediatric practices and their associated pediatric hypertension subspecialists whose behavior
the QIC is attempting to change. In order to know if these practices and subspecialists have
changed their behaviors, we will look at patient data. To be included in the data cohort,
patients must have a blood pressure (BP) measurement that is elevated (>= 90th percentile for
patient's sex, age, and height, or >=120/80 (regardless of sex/age/ height) at a healthcare
maintenance visit or non-acute care visit (e.g. chronic disease follow-up visit). The
following patients would be excluded from the data cohort:

- Prior hypertension or elevated BP diagnosis. Patient can have prior elevated BP
measurements as long as no diagnosis has been made

- BP>95th percentile + 30mm or >180/120 or symptomatic patient

- Prior diagnosis of congenital heart disease, chronic kidney disease, urologic disease
(e.g. posterior urethral valve, vesicoureteral reflux) or organ transplant,

- Previously included in BP-CATCH data entry

- Acute care visit (e.g., fever, viral illness, asthma attack, pain in any body part,
etc.)

Inclusion:

- Primary care pediatric practices who see children ages 3-22 years old.

- Practice must be able to field a 3-person core improvement team who can participate in
the quality improvement collaborative.

Exclusion:

- Non-pediatric practices