Integrating social risk alerts into primary care workflows may improve blood pressure control
Social risk–informed decision support and blood pressure control in a primary care cluster randomized controlled trial
Original Research
Integrating Social Risk Alerts Into Primary Care Workflows May Improve Blood Pressure Control
Background: Screening for social risks has expanded in recent years. However, less is known about how integrating social risk information into clinical workflows influences patient outcomes. The study was conducted in the OCHIN network, a national consultancy for community health care organizations. Six clinics implemented the intervention; 44 clinics served as controls and were followed for 12 months.
What They Found: The intervention included electronic health record-integrated alerts identifying patients overdue for social risk screening and decision-support prompts to care teams. The alerts were for adults with uncontrolled hypertension, uncontrolled diabetes, or visit no-show rates of 50% or higher, with some alerts prompting clinicians to consider medication affordability and adherence barriers. Blood pressure control over time improved in both groups. The odds of blood pressure control increased over time in intervention clinics compared with control clinics. There was no statistically significant difference in blood sugar (Hemoglobin A1c) control between groups. Intervention clinics were significantly more likely to complete social risk screenings and document social risks using Z-codes.
Implications: This trial adds evidence that integrating social risk information into primary care workflows may be associated with modest improvements in hypertension control.
Social Risk–Informed Decision Support and Blood Pressure Control in a Primary Care Cluster R
andomized Controlled Trial
Brenda M. McGrath, PhD, et al
OCHIN, Inc, Portland, Oregon
END
Integrating Social Risk Alerts Into Primary Care Workflows May Improve Blood Pressure Control
Background: Screening for social risks has expanded in recent years. However, less is known about how integrating social risk information into clinical workflows influences patient outcomes. The study was conducted in the OCHIN network, a national consultancy for community health care organizations. Six clinics implemented the intervention; 44 clinics served as controls and were followed for 12 months.
What They Found: The intervention included electronic health record-integrated alerts identifying patients overdue for social risk screening and decision-support prompts to care teams. The alerts were for adults with uncontrolled hypertension, uncontrolled diabetes, or visit no-show rates of 50% or higher, with some alerts prompting clinicians to consider medication affordability and adherence barriers. Blood pressure control over time improved in both groups. The odds of blood pressure control increased over time in intervention clinics compared with control clinics. There was no statistically significant difference in blood sugar (Hemoglobin A1c) control between groups. Intervention clinics were significantly more likely to complete social risk screenings and document social risks using Z-codes.
Implications: This trial adds evidence that integrating social risk information into primary care workflows may be associated with modest improvements in hypertension control.
Social Risk–Informed Decision Support and Blood Pressure Control in a Primary Care Cluster R
andomized Controlled Trial
Brenda M. McGrath, PhD, et al
OCHIN, Inc, Portland, Oregon
END