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Peer Comparison Feedback to Providers to Improve Hypertension Control

Primary Purpose

Hypertension

Status

Active

Phase

Not Applicable

Locations

United States

Study Type

Interventional

Intervention

Peer Comparison Message

About this trial

This is an interventional health services research trial for Hypertension

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Primary Care Providers who have at =>30 patients hypertension as determined by the HTN quality metric
Patients aged 18-85 with hypertension in their encounter diagnosis within the last 2 years (office visits, ED/Urgent Care, Hospital, Hospital Encounter, and Prenatal Visit)
Patients will be counted in the denominator of the quality metric if they have both systolic and diastolic BP measures from an encounter with their PCP department within the last year (including office visits, well child, prenatal visit, consult visit, confidential, e-visit, nursing only, home/offsite visit, and telemedicine) that is >140 for systolic BP and >90 diastolic BP

Exclusion Criteria:

Primary Care Providers includes providers with <30 patients in the HTN quality metric
Patients will be excluded if they are 66 and older with a frailty diagnosis and those with an advanced illness diagnosis within the past year; 81 and older with frailty diagnosis within the past year
It also excludes patients with end stage renal disease (indicated by evaluation of the GFR, diagnosis of end stage renal disease in last year, dialysis received in last year, or renal transplant) and patients with a pregnancy diagnosis in the last 9 months
It also excludes patients with an end of life indicator (comfort care encounter in last year, comfort care noted in problem list in last year, and comfort care/palliative care procedures in last year)

Sites / Locations

Lancaster General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Control

Intervention

Arm Description

This group will not receive peer comparison messages and will continue with usual care.

This group will receive peer comparison messages.

Outcomes

Primary Outcome Measures

Change in new hypertensive medication prescriptions or an increased dose of hypertensive medication

Change in new hypertensive medication prescriptions or an increased dose of hypertensive medication from baseline to the follow up period, as measured by the proportion of patients with a new prescription or dose placed for hypertensive medications in the electronic health record (EHR) from baseline to follow-up

Secondary Outcome Measures

Change in hypertension control percentage

Change in hypertension control percentage from baseline to follow up period, as measured by percentage increases in a hypertension quality improvement report that is provided to physicians in the electronic health record (EHR) and reflects rate of hypertension control across all patients under the care of that physician.

Full Information

NCT ID

NCT05160012

First Posted

November 9, 2021

Last Updated

October 11, 2023

Sponsor

University of Pennsylvania

1. Study Identification

Unique Protocol Identification Number

NCT05160012

Brief Title

Peer Comparison Feedback to Providers to Improve Hypertension Control

Official Title

Peer Comparison Feedback to Providers to Improve Hypertension Control

Study Type

Interventional

2. Study Status

Record Verification Date

October 2023

Overall Recruitment Status

Active, not recruiting

Study Start Date

April 5, 2022 (Actual)

Primary Completion Date

October 6, 2022 (Actual)

Study Completion Date

January 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

University of Pennsylvania

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

Data Monitoring Committee

5. Study Description

Brief Summary

As part of a roll out of new payment model for physicians based on hypertension control, the investigators will evaluate a monthly peer comparison message to Primary Care Providers at Penn Medicine Lancaster to see whether provider engagement with patients' overall hypertension management increases, as measured by new or increasing doses of anti-hypertensive medications.

Detailed Description

Hypertension (HTN) affects about 30% of US adults, and effective treatment that reduces long-term risk of subsequent cardiovascular disease is widely available; however, only about half of adults maintain good control. HTN control requires diagnosis, initiation of treatment, adherence to medications, and titration of medications. The investigators' prior work from Way2Text and SupportBP showed that there is significant clinical inertia in escalating medications for HTN through increasing dosage or adding new medications. Prior studies have shown that providing feedback to providers with peer comparison data can leverage social norms to improve evidence-based practices in antibiotic and statin prescribing. Penn Medicine Lancaster General Primary Care is rolling out a Hypertension Control Implementation Plan (HCIP) as an initiative to improve hypertension control through creation of a clinic-based pathway to identify patients with hypertension, appropriately measure blood pressure, and prescribe medications to reduce blood pressure. Busy PCPs have competing demands of care, so there is an opportunity to leverage peer comparison to nudge providers to adhere to the HCIP and intensify medications. The study design is a stratified parallel-group cluster-randomized trial. PCPs will be randomized in a 1:1 ratio, stratified by practice, to either: 1) Control: Usual Care- This will include the standard HCIP roll-out, and PCPs can access their HTN control rates using the existing EPIC dashboard.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Hypertension

7. Study Design

Primary Purpose

Health Services Research

Study Phase

Not Applicable

Interventional Study Model

Parallel Assignment

Masking

InvestigatorOutcomes Assessor

Allocation

Randomized

Enrollment

93 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Control

Arm Type

No Intervention

Arm Description

This group will not receive peer comparison messages and will continue with usual care.

Arm Title

Intervention

Arm Type

Experimental

Arm Description

This group will receive peer comparison messages.

Intervention Type

Behavioral

Intervention Name(s)

Peer Comparison Message

Intervention Description

In addition to usual care, PCPs will receive a monthly report as an EPIC in basket message describing what category they are in: If HTN control rate <50th percentile, PCP is told they are below median If HTN control rate is between 50-89th percentile , PCP is told they are below top performer If HTN control rate is between 90-100th percentile, PCP is told they are a high performer

Primary Outcome Measure Information:

Title

Change in new hypertensive medication prescriptions or an increased dose of hypertensive medication

Description

Time Frame

6 months

Secondary Outcome Measure Information:

Title

Change in hypertension control percentage

Description

Time Frame

6 months

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

85 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Primary Care Providers who have at =>30 patients hypertension as determined by the HTN quality metric Patients aged 18-85 with hypertension in their encounter diagnosis within the last 2 years (office visits, ED/Urgent Care, Hospital, Hospital Encounter, and Prenatal Visit) Patients will be counted in the denominator of the quality metric if they have both systolic and diastolic BP measures from an encounter with their PCP department within the last year (including office visits, well child, prenatal visit, consult visit, confidential, e-visit, nursing only, home/offsite visit, and telemedicine) that is >140 for systolic BP and >90 diastolic BP Exclusion Criteria: Primary Care Providers includes providers with <30 patients in the HTN quality metric Patients will be excluded if they are 66 and older with a frailty diagnosis and those with an advanced illness diagnosis within the past year; 81 and older with frailty diagnosis within the past year It also excludes patients with end stage renal disease (indicated by evaluation of the GFR, diagnosis of end stage renal disease in last year, dialysis received in last year, or renal transplant) and patients with a pregnancy diagnosis in the last 9 months It also excludes patients with an end of life indicator (comfort care encounter in last year, comfort care noted in problem list in last year, and comfort care/palliative care procedures in last year)

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Shivan Mehta, MD,MBA,MSHP

Organizational Affiliation

University of Pennsylvania

Official's Role

Principal Investigator

Facility Information:

Facility Name

Lancaster General Hospital

City

Lancaster

State/Province

Pennsylvania

ZIP/Postal Code

17602

Country

United States

12. IPD Sharing Statement

Learn more about this trial

Peer Comparison Feedback to Providers to Improve Hypertension Control

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