The Extent of Implementation of Clinical Practice Guidelines for Pediatric High Blood Pressure Follow-up in the Largest Healthcare System in Central Massachusetts

Abstract

Objective: To describe the extent to which the American Academy of Pediatrics’ (AAP) 2017 clinical practice guidelines, for follow-up after high blood pressure (BP) screening, were implemented in the largest healthcare system in Central Massachusetts and to assess differences across patient and clinic-level factors.

Methods: We extracted electronic health record data for children aged 3-17 years who had an outpatient primary care visit within the system during 2018 with a high BP screening (according to AAP guidelines). We used direct estimation to determine receipt of AAP guideline adherent follow-up as follow-up within 6 months for elevated screening (+2-week buffer) and within 2 weeks for hypertensive screening (+2-week buffer). Differences in the receipt of guideline adherent follow-up were assessed via multilevel mixed effects logistic regression.

Results: We identified 4,563 children (median age 12 years, 57% male). Overall, guideline adherent follow-up was received by 17.7% of children within the recommended time interval (+ 2-week buffer); 27.4% for those whose index BP screening was elevated and 5.4% for those whose index BP screening was hypertensive. Modeling revealed that receipt of adherent follow-up was positively associated with older age and belonging to a clinic with more providers; and negatively associated with belonging to a clinic in a rural location and with a higher proportion of patients covered by Medicare/Medicaid.

Conclusion: We found insufficient implementation of the AAP’s guidelines for high BP follow-up in 2018. Few children received guideline adherent follow-up after high BP screening and most differences in adherence were related to clinic resources.