Use of Electronic Health Records to Characterize Patients with Uncontrolled Hypertension in Two Large Health System Networks.

Autor:	Lu Y; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT., Keeley EC; Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL., Barrette E; Global Health Economics & Outcomes Research, Medtronic, Inc., Cooper-DeHoff RM; Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL.; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL., Dhruva SS; School of Medicine, University of California San Francisco, CA.; Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, CA., Gaffney J; Global Reimbursement & Health Economics, Coronary & Renal Denervation, Medtronic, Inc., Gamble G; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT., Handke B; Global Health Economics & Outcomes Research, Medtronic, Inc., Huang C; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT., Krumholz HM; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT., McDonough Rowe CW; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL., Schulz W; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.; Center for Medical Informatics, Yale School of Medicine, New Haven, CT.; Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT., Shaw K; Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL., Smith M; Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL., Woodard J; Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL., Young P; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT., Ervin K; National Evaluation System for health Technology Coordinating Center (NESTcc), Medical Device Innovation Consortium, Arlington, VA, USA., Ross JS; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT.; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2023 Jul 28. Date of Electronic Publication: 2023 Jul 28.
DOI:	10.1101/2023.07.26.23293225
Abstrakt:	Background: Improving hypertension control is a public health priority. However, uncertainty remains regarding the optimal way to identify patients with uncontrolled hypertension using electronic health records (EHR) data. Methods: In this retrospective cohort study, we applied computable definitions to the EHR data to identify patients with controlled and uncontrolled hypertension and to evaluate differences in characteristics, treatment, and clinical outcomes between these patient populations. We included adult patients (≥18 years) with hypertension receiving ambulatory care within Yale-New Haven Health System (YNHHS; a large US health system) and OneFlorida Clinical Research Consortium (OneFlorida; a Clinical Research Network comprised of 16 health systems) between October 2015 and December 2018. We identified patients with controlled and uncontrolled hypertension based on either a single blood pressure (BP) measurement from a randomly selected visit or all BP measurements recorded between hypertension identification and the randomly selected visit). Results: Overall, 253,207 and 182,827 adults at YNHHS and OneFlorida were identified as having hypertension. Of these patients, 83.1% at YNHHS and 76.8% at OneFlorida were identified using ICD-10-CM codes, whereas 16.9% and 23.2%, respectively, were identified using elevated BP measurements (≥ 140/90 mmHg). Uncontrolled hypertension was observed among 32.5% and 43.7% of patients at YNHHS and OneFlorida, respectively. Uncontrolled hypertension was disproportionately higher among Black patients when compared with White patients (38.9% versus 31.5% in YNHHS; p<0.001; 49.7% versus 41.2% in OneFlorida; p<0.001). Medication prescription for hypertension management was more common in patients with uncontrolled hypertension when compared with those with controlled hypertension (overall treatment rate: 39.3% versus 37.3% in YNHHS; p=0.04; 42.2% versus 34.8% in OneFlorida; p<0.001). Patients with controlled and uncontrolled hypertension had similar rates of short-term (at 3 and 6 months) and long-term (at 12 and 24 months) clinical outcomes. The two computable definitions generated consistent results. Conclusions: Computable definitions can be successfully applied to health system EHR data to conduct population surveillance for hypertension and identify patients with uncontrolled hypertension who may benefit from additional treatment.
Databáze:	MEDLINE
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