Initial Working DRAFT for Stakeholder Input and Refinement
Note: This Knowledge Portal demo will illustrate the ability to access/display computable evidence and guidance on particular topics, such as can be done for COVID anticoagulation in the current ACTS Recommendation Summary Browser demo. FHIR standards for evidence and citation resources can be used to gather this information (e.g., from fevir.net platform), for the ACTS demo.
A DRAFT/under-development version of the clickable demo is here; this will be integrated with another clickable demo here. A draft document outlining considerations for evolving from the clickable demo to a production product is here.
|AHRQ ACTS Knowledge Portal|
Sort Results by:
|Full Text Search|
"Hypertension" "BP Control"
(Robust cross-references/thesaurus to enhance searches/shown to the user as predictive options as they type)
(The ">" indicates there is an expandable list of available filter options)
x "Designed for Patients" x "AHRQ Resources"
(Applied Filters listed here)
^ Media Type
|x "Videos" x "PDF / Word Document"|
|(results would be tables/tools as being demonstrated in the Recommendation Summary Browser part of the ACTS LHS Concept Demo; demo content focuses on anticoagulation for COVID-19)|
(The "^" indicates the list of available options is already expanded and visible to the user)
Blood Pressure and the New ACC/AHA Hypertension Guidelines (ACC/AHA): The ACC/AHA hypertension guidelines cover virtually all aspects of the diagnosis, evaluation, monitoring, secondary causes as well as drug and non-drug treatment of hypertension. Substantial and appropriate emphasis has been given to the strategies necessary for accurate measurement of blood pressure in any setting where valid blood pressure measurements are desired.
Blood Pressure Control Evidence and Resources (EvidenceNOW): High blood pressure is a major risk factor for heart attack, heart failure, stroke and chronic kidney disease. High blood pressure is very common, affecting about 30 percent of adults in the United States. In 2013, high blood pressure was the main or a contributing cause of death for more than 360,000 people in the United States. Substantial clinical evidence shows that controlling high blood pressure results in a significant reduction in heart attacks and strokes .
Brent M. Egan, Jiexiang Li, Susan E. Sutherland, Michael K. Rakotz, Gregory D. Wozniak. Hypertension Control in the U.S. 2009 to 2018: Factors Underlying Falling Control Rates During 2015 to 2018 Across Age and Race-Ethnicity Groups. Hypertension. June 2021. DOI.org/10.1161/HYPERTENSIONAHA.120.16418 (AMA)
Alejandro Arrieta, John Woods, Gregory Wozniak, Stavros Tsipas, Michael Rakotz, Stephen Jay. Return on Investment of Self-Measured Blood Pressure Is Associated with Its Use in Preventing False Diagnoses, not Monitoring Hypertension, PLOS ONE. June 18, 2021. https://doi.org/10.1371/journal.pone.0252701 (AMA)
Jing Fang, Cecily Luncheon, Hilary K Wall, Gregory Wozniak, Fleetwood Loustalot. Self-measured blood pressure monitoring among adults with self-reported hypertension in 20 US states and the District of Columbia, 2019. American Journal of Hypertension, June 7, 2021. doi.org/10.1093/ajh/hpab091. (AMA)
Muntner P, Hardy ST, Fine LJ, Jaeger BC, Wozniak G, Levitan EB, Colantonio LD. Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018. JAMA. Published online September 9, 2020. DOI.org/10.1001/jama.2020.14545 (AMA)
Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G; on behalf of the American Heart Association and the American Medical Association. Self-measured blood pressure monitoring at home: a joint policy statement from the American Heart Association and American Medical Association. Circulation. 2020. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000803 (AMA)
^ QI Program Tools
QI Program Tools
A Facilitator’s Primary Care Toolkit to Improve Heart Health (EvidenceNOW): This toolkit introduces the ABCS of heart health and provides checklists, action plans, and other instructions to guide primary care practices to implement evidence-based guidelines, transform health care delivery, and improve patients’ heart health.
A Team Approach to Documenting Electronic Health Records (EHRs) (EvidenceNOW): This online continuing medical education (CME) module explains how to implement a team-based approach to enter documentation (scribe) and how it can be supported and improved by electronic health record (EHR) systems.
Advantages and Disadvantages of Registries: Population Health (EvidenceNOW): Registries can complement paper records or electronic health records (EHRs), which frequently do not have the functions needed for population management. This resource discusses the advantages and disadvantages of creating and using registries.
Aspirin Workflow: Ensuring Evidence-Based Care with Medical Assistants (EvidenceNOW): This workflow shows how medical assistants can provide a check to ensure that evidence-based care is delivered by identifying patients with heart disease who, according to protocol, should have, but have not, been prescribed aspirin.
Hypertension Control Change Package (Million Hearts): The Hypertension Control Change Package presents a listing of process improvements that outpatient clinical settings can implement as they seek optimal hypertension control. It is composed of change concepts, change ideas, and evidence- or practice-based tools and resources.
Taking Control of My Blood Pressure: D’Angelo’s Story (NACHC via Million Hearts)
Target: BP - SMBP Infographic: How to measure your blood pressure at home. (AHA/AMA via Million Hearts)
Targeting Hypertension (AMA): Patient-focused hypertension control materials available to AMA members.
High Blood Pressure (NLM/Medline Plus)
Assessment of Studies of Quality Improvement Strategies to Enhance Outcomes in Patients with Cardiovascular Disease (JAMA): What are effective quality improvement strategies (patient-, clinician-, and health system–level) for improving outcomes in patients with cardiovascular disease (CVD), and how are these strategies best implemented?
U.S. Health Care Should Follow This Blueprint to Boost BP Control (AMA): There has been inadequate and worsening control of high blood pressure in the United States. This has likely been exacerbated by the COVID-19 pandemic, which exposed shortcomings of the health care delivery system. But there is a blueprint for change that clinicians and health care delivery systems can follow to improve blood-pressure control, says a new article.
Assessment of hypertension QI approaches JAMA: "QI strategies such as patient support, community support, strengthening infrastructure, and technology-delivered strategies were all found to be cost-effective."
^Software / Applications / Executable CDS Interventions
Executable CDS Interventions
See this preliminary ACTS Worksheet on AHRQ Assets produced in early 2020 by Rich Boyce/University of Pittsburgh; begins to outline a taxonomy of AHRQ asset types, which types are available on which AHRQ websites, and specific assets pertinent to the Mae scenario.
Explore opportunities to leverage guidance from NLM's Medline team about how to effectively use Medline; e.g., can/should we add at least a mention of leveraging Medline as outlined in this article as a component of functions this portal should ultimately address? Even if only mention this (including link to article above) in the 'Notes' companion to this document.
Portal Mockup demo notes
Notes from 8/13/2021 ACTS Evidence/Guidance Computability Tool Requirements Project meeting
20210813 Zoom Chat:
14:26:20 From Surbhi Shah : what about creating a repertoire of synonymous terminology
14:27:13 From Jerry Osheroff : Great, yes Surbhi - the idea is that there would be a ‘thesaurus’ that would be used to process entry terms - e.g., like google.
Added in "Full Text Search" field as (Robust cross-references/thesaurus to enhance searches/shown to the user as predictive options as they type)
14:27:54 From Surbhi Shah : exactly
14:55:15 From Jerry Osheroff : Tom - suggest we add “value sets” and ‘quality measures’ to the sort options/buckets.
Added as major sort fields at the bottom of the form
15:02:21 From Sandra Zelman Lewis : We also need to be sure to include (add?) date or currency and some form of quality rating for the articfacts.
Added at the top as - Sort Results by:
- Publish Date / Release Date
- Quality Rating / Quality Metrics
20210813 Meeting Notes
Strong preference to remove the Top Line Nav links, as it will cause confusion / artificially limit the tool user
Recommendation to expand the functionality for guideline searches to include ability to filter studies that do/do not include a specified guideline
Recommendation for ability to tag data/artifact types, referencing the ACTS Worksheet on AHRQ Assets as an example.
Show how mockup could leverage a “future” Reference Implementation with FHIR / API standards etc., to demo evidence/guidance tool FAIRness, and apply to use cases appropriate for each “actor” around the LHS cycle, who should need quick and easy access to the latest best evidence/guidance/tools etc. Maybe also put/display the patient/caregiver as a major actor in the center of LHS cycle or Demo Concept infographic?. Use cases/ actors could include:
- Patient/ Caregiver – Find latest recommendations / evidence / tools for my condition, needs, goals
- Clinician (and demo shared decision making) - Find latest recommendations for a patient group; understand disagreement among recommendations
- Systematic Reviewer - Identify recommendation differences, assess evidence quality
and identify gaps
- Guideline developer - Find all recommendations and rationale/evidence related to the recommendation I’m developing
- Guideline disseminator - Surface my recommendation(s) for others to see and utilize
- CDS developer/ implementer - Identify evidence-based recommendations useful for informing CDS intervention
- Other Actors that Gather, Analyze & Apply Data About Care Processes & Results, AND to Conduct Needed New Research:
- Measure developer – find measures on a topic
- Health systems executives? – find how their performance on a target compares with others
- Policy makers (Fed like CMS, and private) – identify broad care gaps and opportunities to better put evidence and guidance into action
- Researchers – identify evidence gaps on a target that could be closed with additional research
Tie above to Mae Patient Journey and Marketplace (for app access) and Care plan (for tools to support plan execution) portions of concept demo
Show how CDS Connect Repository and Authoring Tool and the CEDAR API would interact with the Portal