Working with a team of primary care clinicians, medical informatics guideline experts, and experts on hypertension, researchers for this project will revise the existing automated decision support system for evidence-based management of primary hypertension -- ATHENA DSS -- to upgrade to the latest hypertension guidelines. We call the new system ATHENA-HTN. During year 1 of the project we plan to install the system and implement it so our collaborating clinicians can become familiar with it and help us fine-tune the installation. We then plan to implement the system in primary care clinics in the Department of Veterans Affairs' Veterans Integrated Service Network (VISN) 1, New England Healthcare Network, in order to provide recommendations to clinicians at the time of patient visits in primary care outpatient clinics.
Working with the collaborating on-site principal investigators in VISN 1, we will then recruit primary care clinicians to participate in a clinical trial evaluating the implementation of ATHENA-HTN to assist clinicians in following practice guidelines. ATHENA-HTN will present recommendations to clinicians for guideline-based patient management at the time of the patients' outpatient clinic visits with their primary care doctor. We also plan to study the extent to which the clinicians use the ATHENA Decision Support System, including the number of times they interact with it and enter new information. As the ATHENA pop-up window (which appears on the clinicians' PDA or computer screen) allows clinician to enter feedback comments to the developers, we plan to analyze these comments for information they provide about clinicians' perceptions of the system -- for example, about clinicians' perceptions of barriers and facilitators for following the guideline recommendations.
We also plan to explore organizational factors, including clinician characteristics and clinic-unit characteristics, that might predict the impact on clinicians' use of the ATHENA Decision Support System and their adherence to its guideline recommendations. The organizational component of the study will also include a cost analysis.