Personalized Physician Learning to Improve Hypertension Care
Personalized Physician Learning to Improve Hypertension Care
In this project the investigators implement and test the ability of a Personalized Physician
 Learning (PPL) intervention to improve hypertension (HT) care with the following specific
 aims:

 Specific Aim 1: Implement two versions of a Personalized Physician Learning (PPL)
 intervention and assess the ability of these interventions to improve hypertension control in
 primary care practice.

 -  Hypothesis 1: Patients of physicians who receive the REAL+PPL Intervention (Group 1)
 will subsequently have better HT control compared to patients of control group
 physicians (Group 3).

 -  Hypothesis 2: Patients of physicians who receive the SIM+PPL Intervention (Group 2) will
 subsequently have better HT control compared to patients of control group physicians
 (Group 3).

 -  Hypothesis 3: Patients of physicians who receive the REAL+PPL (Group 1) will
 subsequently have better HT control compared to patients of physicians who receive the
 SIM+PPL (Group 2).

 Specific Aim 2: Assess the cost-effectiveness of the SIM+PPL and REAL+PPL interventions,
 relative to no intervention.
The objective of this project is to improve hypertension (HT) control by implementing two
 Personalized Physician Learning interventions designed for primary care physicians (PCPs).
 Improved HT control has long been identified as a major national health care priority because
 uncontrolled HT is a leading cause of stroke(CVA), congestive heart failure (CHF), chronic
 kidney disease (CKD), end-stage renal disease (ESRD),myocardial infarction (MI), and other
 adverse health events. The cost of uncontrolled HT and its sequelae is estimated to be at
 least $100 billion dollars a year in the U.S., and there has been only minimal improvement in
 HT care in recent decades. Currently, of an estimated 68 million Americans with HT, about 42
 million remain uncontrolled.

 Personalized Physician Learning (PPL) interventions are powerful enough to change physician
 behavior and improve HT care. The PPL interventions in this project are directed to
 individual primary care physicians(PCPs) using a simple 3-step approach: (a) Analyze each
 physician's pre-intervention patterns of HT care to identify specific failures of physician
 decision making in HT care, (b) Provide each physician with a series of personalized HT
 learning cases designed to correct the failures of decision making that result in that
 physician's observed patterns of HT care. Learning cases provide iterative on-screen feedback
 of blood pressure (BP) changes in response to a sequence of changes in therapy,
 expert-generated suggestions for better HT care, and adaptive selection of subsequent cases
 until identified errors in decision making are mastered. (c) Assess intervention impact on
 the care of actual patients with HT in the post-intervention period, to assess transfer of
 learning from the simulated to the office practice environment. The PPL intervention strategy
 is based on recent work in cognitive science and learning theory and has been successfully
 applied in other research and educational settings, although it has yet to be applied to HT
 care.
Inclusion Criteria:

 -  Practicing physician at 1 of 2 medical groups.

 -  Be a general internist of family physician.

 -  Provide ongoing clinical care to at least 25 adult patients with uncontrolled
 hypertension. Additional patient criteria include;

 -  22 years or more on date of physician randomization.

 -  Charlson score less than 4.

 -  Be linked to a primary care physician who has consented to the study.

 -  Have 2 consecutive office blood pressure readings above the 7th Report of the Joint
 National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
 Pressure (JNC7) goal, within a 12 month time period.

 Exclusion Criteria:

 -  Physicians practicing at a second clinic for more than 1 day per week. Additional
 patient criteria;

 -  Less than 22 years of age.

 -  Charlson score of >= 4