Project Details - Ongoing
- Grant Number:R01 HS023328
- Funding Mechanism:
- AHRQ Funded Amount:$2,230,821
- Principal Investigator:
- Project Dates:7/1/2015 to 4/30/2020
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
Among adults in the United States, 78 million have diagnosed hypertension. It represents a major risk factor for morbidity and mortality and leads to heart disease, stroke, and chronic kidney disease. Although there are multiple modalities for treatment, only 53 percent of U.S. adults with hypertension have their blood pressure controlled. Researchers have noted a phenomenon called clinical inertia in which, despite objective evidence that a patient’s disease is not under control, medication regimen intensification occurs only 20 percent of the time. Clinical inertia with blood pressure control may be due to clinical uncertainty that a single blood pressure measured in the clinic may be representative of an individual’s typical blood pressure.
Home blood pressure monitoring by the patient is often proposed as a means to address this problem and to better define the patient’s blood pressure range outside the clinical setting. However, these home measurements bring more data to the clinician but do not necessarily improve the clinician’s understanding of the patient’s control. Improving graphical representation of the data may improve this situation. In addition, treatment planning frequently involves negotiation between patient and physician, which is predicated on a shared understanding of blood pressure control.
The project team will determine the optimal display of blood pressure data for patients and their physicians in order to facilitate shared decisionmaking about blood pressure control and treatment. To accomplish this goal, the team will investigate how graphic displays of blood pressure are perceived by patients and physicians and what information should be included in the display. Based on physician and patient input, and guided usability and design principles, the team will iteratively refine and formally test candidate displays. Finally, they will seek to understand how graphic presentation of blood pressure data influences shared decisionmaking during patient visits.
The specific aims of the project are as follows:
- Determine patient and physician information needs about clinic and home blood pressure data
- Evaluate how characteristics of blood pressure data interact with characteristics of the data display to influence patient and physician perceptions of blood pressure control
- Iteratively design a shared display of blood pressure and medication data that will inform the work of patients and physicians making decisions together in the ambulatory setting
- Examine patient-physician encounters to determine how an effective shared data display influences shared decisionmaking and goal-setting in ambulatory clinic visits for patients with hypertension
The hypothesis is that improved graphic display of blood pressure data will help physicians and patients better understand the scope of the patient’s blood pressure problem and assist them in reaching a shared decision about the need for potential treatment or treatment modification.