408 - Evaluating the Consistency of Pediatric Hypertension Diagnosis in Community Clinics: A Quality Improvement Program Guided by Reach, Effectiveness, Adoption, Implementation, Maintenance Framework

Publication Number: 1391.408

Sudha Garimella, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Shuvangee Dhar, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Xiaofang Lai, Prisma Health/Clemson University, Clemson, SC, United States; Caitlin Koob, Medical University of South Carolina, Charleston, SC, United States; J. Blakely Amati, Prisma Health/University of South Carolina School of Medicine, Greenville, SC, United States

Background: Despite the substantial prevalence and consequences of pediatric hypertension (HTN), children remain underdiagnosed. Through a Community Health Needs Assessment, clinics within a large hospital system were found to have suboptimal adherence to the 2017 American Academy of Pediatrics (AAP) guidelines for diagnosing pediatric HTN.

Objective: A quality improvement (QI) project was conducted to enhance adherence to the guidelines for children aged 3-18 years, and subsequently evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Design/Methods: The QI project was designed using the Institute for Healthcare Improvement model and implemented at 11 clinics, three family medicine/medicine-pediatrics, and eight pediatric. A two-hour education session was provided in June 2024 to review the guidelines and standardized pediatric blood pressure (BP) measurement techniques. Two- and four-month check-ins, and a six-month final meeting were scheduled for clinics to review the plan-do-study-act cycles based on key drivers (Figure 1). Practices conducted baseline and monthly random chart audits over six months, recording well-child BP measurements and measurement technique, elevated (flagged if above the 90th percentile), and repeated BPs. Data collection was conducted at pre-intervention (May 2024), midpoint (September 2024), post-intervention (December 2024), and 6-month (May 2025) follow-up periods.

Results: We reached 9,781 patients, representing approximately 25.3% of the pediatric population systemwide. The most commonly used interventions were staff education (100%) and displaying pediatric HTN algorithms (87.5%). The average percentage of BP screening at well-child visits remained stable over time with no significant change (p>0.05). However, clinics serving both adults and children showed an increase from 93.79% to 98.39% at post-intervention, decreasing to 96.49% at the six-month maintenance mark (p < 0.0001). Repeat BP measurement improved from 5.58% at pre-intervention to 11.22% at follow-up, peaking at 17.29% in the post-intervention period across all clinics, representing the effectiveness of the program.

Conclusion(s): Overall, our project suggests improved adherence to best practice guidelines through staff education. However, a decline in average repeat BP readings at the 6-month mark was noted, potentially due to inadequate retention of educational interventions or modifications in the workforce. Future work should explore opportunities to enhance long-term adherence to guidelines, such as the adoption of electronic health record decision support tools.

Figure 1. Key Driver Diagram
Interventions implemented in the QI project based on key drivers established to achieve the primary goal of improving adherence to the 2017 AAP clinical guidelines.