{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:56:31Z","timestamp":1776099391026,"version":"3.50.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS023328"],"award-info":[{"award-number":["R01HS023328"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, we face an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. We designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We used an iterative, rapid-prototyping, user-centred design approach to determine the most appropriate designs for this data display. We relied on visual cognition and human factors principles when designing our display. Feedback was provided by expert members of our multidisciplinary research team and through a series of end-user focus groups, comprised of either hypertensive patients or their healthcare providers required from eight academic, community-based practices in the Midwest of the United States.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 40 participants were recruited to participate in patient (N\u2009=\u200916) and provider (N\u2009=\u200924) focus groups. We describe the conceptualization and development of data display for shared decision making around hypertension. We designed and received feedback from both patients and healthcare providers on a number of design elements that were reported to be helpful in understanding blood pressure measurements.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We developed a data display for substantial amounts of blood pressure measurements that is both simple to understand for patients, but powerful enough to inform clinical decision making. The display used a line graph format for ease of understanding, a LOWESS function for smoothing data to reduce the weight users placed on outlier measurements, colored goal range bands to allow users to quickly determine if measurements were in range, a medication timeline to help link recorded blood pressure measurements with the medications a patient was taking. A data display such as this, specifically designed to encourage shared decision making between hypertensive patients and their healthcare providers, could help us overcome the clinical inertia that often results in a lack of treatment intensification, leading to better care for the 35 million Americans with uncontrolled hypertension.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-021-01598-4","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T09:03:15Z","timestamp":1628154195000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Home blood pressure data visualization for the management of hypertension: using human factors and design principles"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0191-136X","authenticated-orcid":false,"given":"Pete","family":"Wegier","sequence":"first","affiliation":[]},{"given":"Jeffery L.","family":"Belden","sequence":"additional","affiliation":[]},{"given":"Shannon M.","family":"Canfield","sequence":"additional","affiliation":[]},{"given":"Victoria A.","family":"Shaffer","sequence":"additional","affiliation":[]},{"given":"Sonal J.","family":"Patil","sequence":"additional","affiliation":[]},{"given":"Michael L.","family":"LeFevre","sequence":"additional","affiliation":[]},{"given":"K. D.","family":"Valentine","sequence":"additional","affiliation":[]},{"given":"Mihail","family":"Popescu","sequence":"additional","affiliation":[]},{"given":"Linsey M.","family":"Steege","sequence":"additional","affiliation":[]},{"given":"Akshay","family":"Jain","sequence":"additional","affiliation":[]},{"given":"Richelle J.","family":"Koopman","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"key":"1598_CR1","unstructured":"National Healthcare Quality and Disparity Reports: Adults with hypertension with blood pressure less than 140\/90 mm\/Hg, United States, 1999\u20132014. https:\/\/nhqrnet.ahrq.gov\/inhqrdr\/."},{"issue":"1","key":"1598_CR2","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.1161\/01.CIR.102.1.11","volume":"127","author":"AS Go","year":"2013","unstructured":"Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics\u20142013 update. Circulation. 2013;127(1):e11-240.","journal-title":"Circulation"},{"issue":"12","key":"1598_CR3","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1161\/CIR.0000000000000558","volume":"137","author":"EJ Benjamin","year":"2018","unstructured":"Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics\u20142018 update. Circulation. 2018;137(12):116\u2013426.","journal-title":"Circulation"},{"issue":"8352","key":"1598_CR4","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1016\/S0140-6736(83)92244-4","volume":"2","author":"G Mancia","year":"1983","unstructured":"Mancia G, Bertinieri G, Grassi G, et al. Effects of blood-pressure measurement by the doctor on patient\u2019s blood pressure and heart rate. Lancet. 1983;2(8352):695\u20138.","journal-title":"Lancet"},{"issue":"6","key":"1598_CR5","first-page":"633","volume":"135","author":"PD Neufeld","year":"1986","unstructured":"Neufeld PD, Johnson DL. Observer error in blood pressure measurement. Can Med Assoc J. 1986;135(6):633\u20137.","journal-title":"Can Med Assoc J"},{"issue":"10","key":"1598_CR6","doi-asserted-by":"publisher","first-page":"717","DOI":"10.7326\/0003-4819-148-10-200805200-00004","volume":"148","author":"EA Kerr","year":"2008","unstructured":"Kerr EA, Zikmund-Fisher BJ, Klamerus ML, Subramanian U, Hogan MM, Hofer TP. The role of clinical uncertainty in treatment decisions for diabetic patients with uncontrolled blood pressure. Ann Intern Med. 2008;148(10):717\u201327.","journal-title":"Ann Intern Med"},{"issue":"1","key":"1598_CR7","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1186\/1471-2296-15-130","volume":"15","author":"J-P Lebeau","year":"2014","unstructured":"Lebeau J-P, Cadwallader J-S, Aubin-Auger I, et al. The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review. BMC Fam Pract. 2014;15(1):398\u2013310.","journal-title":"BMC Fam Pract"},{"issue":"4","key":"1598_CR8","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1161\/HYPERTENSIONAHA.111.174367","volume":"58","author":"MJ Crowley","year":"2011","unstructured":"Crowley MJ, Smith VA, Olsen MK, et al. Treatment intensification in a hypertension telemanagement trial. Hypertension. 2011;58(4):552\u20138.","journal-title":"Hypertension"},{"key":"1598_CR9","unstructured":"Kolata G. Blood pressure, a reading with a habit of straying. The New York Times; 2015."},{"issue":"3","key":"1598_CR10","doi-asserted-by":"publisher","first-page":"185","DOI":"10.7326\/0003-4819-159-3-201308060-00008","volume":"159","author":"K Uhlig","year":"2013","unstructured":"Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013;159(3):185\u201394.","journal-title":"Ann Intern Med"},{"issue":"7","key":"1598_CR11","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1097\/00004872-199816070-00010","volume":"16","author":"T Ohkubo","year":"1998","unstructured":"Ohkubo T, Imai Y, Tsuji I, et al. Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens. 1998;16(7):971\u20135.","journal-title":"J Hypertens"},{"issue":"3","key":"1598_CR12","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1177\/0272989X19832882","volume":"39","author":"P Wegier","year":"2019","unstructured":"Wegier P, Armstrong BA, Shaffer VA. Aiding risk information learning through simulated experience (ARISE): a comparison of the communication of screening test information in explicit and simulated experience formats. Med Decis Mak. 2019;39(3):196\u2013207.","journal-title":"Med Decis Mak"},{"issue":"10","key":"1598_CR13","doi-asserted-by":"publisher","first-page":"e11027","DOI":"10.2196\/11027","volume":"20","author":"AM Scherer","year":"2018","unstructured":"Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A, Zikmund-Fisher BJ. Improving the understanding of test results by substituting (not adding) goal ranges: web-based between-subjects experiment. J Med Internet Res. 2018;20(10):e11027\u2013e11013.","journal-title":"J Med Internet Res"},{"issue":"6","key":"1598_CR14","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1177\/0272989X10364244","volume":"30","author":"BJ Zikmund-Fisher","year":"2010","unstructured":"Zikmund-Fisher BJ, Fagerlin A, Ubel PA. A demonstration of \u201cless can be more\u201d in risk graphics. Med Decis Mak. 2010;30(6):661\u201371.","journal-title":"Med Decis Mak"},{"issue":"8","key":"1598_CR15","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1111\/j.1751-7176.2009.00150.x","volume":"11","author":"T Kabutoya","year":"2009","unstructured":"Kabutoya T, Ishikawa J, Hoshide S, Eguchi K, Shimada K, Kario K. A home blood pressure monitor equipped with a graphic function facilitates faster blood pressure control than the conventional home blood pressure monitor. J Clin Hypertens. 2009;11(8):422\u20135.","journal-title":"J Clin Hypertens"},{"key":"1598_CR16","unstructured":"Belden JL, Patel J, Lowrance NJ, et al. Inspired EHRs: designing for clinicians. In: Columbia, MO: The Curators of the University of Missouri; 2014. http:\/\/inspiredehrs.org."},{"issue":"195","key":"1598_CR17","first-page":"1","volume":"20","author":"RJ Koopman","year":"2020","unstructured":"Koopman RJ, Canfield SM, Belden JL, et al. Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs. BMC Med Inform Decis Mak. 2020;20(195):1\u201315.","journal-title":"BMC Med Inform Decis Mak"},{"issue":"3","key":"1598_CR18","doi-asserted-by":"publisher","first-page":"e11366","DOI":"10.2196\/11366","volume":"21","author":"VA Shaffer","year":"2019","unstructured":"Shaffer VA, Wegier P, Valentine KD, et al. Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data. J Med Internet Res. 2019;21(3):e11366\u2013e11314.","journal-title":"J Med Internet Res"},{"key":"1598_CR19","doi-asserted-by":"crossref","unstructured":"Shaffer VA, Wegier P, Valentine KD, et al. Use of enhanced data visualization to improve patient judgments about hypertension control. Med Decis Mak. 2020.","DOI":"10.1177\/0272989X20940999"},{"key":"1598_CR20","unstructured":"U.S. Preventative Services Task Force Web site. https:\/\/www.uspreventiveservicestaskforce.org. Accessed."},{"key":"1598_CR21","volume-title":"Rapid assessment process: an introduction","author":"J Beebe","year":"2001","unstructured":"Beebe J. Rapid assessment process: an introduction. Walnut Creek: Rowman Altamira Press; 2001."},{"issue":"2","key":"1598_CR22","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qual Res Psychol"},{"key":"1598_CR23","unstructured":"Wearable Technology Market worth $56.8 billion by 2025 with a growing CAGR of 11.28%. MarketsandMarkets Web site. https:\/\/www.marketsandmarkets.com\/PressReleases\/wearable-electronics.asp. Accessed."},{"issue":"4","key":"1598_CR24","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1161\/HYPERTENSIONAHA.109.140798","volume":"55","author":"TW Hansen","year":"2010","unstructured":"Hansen TW, Thijs L, Li Y, et al. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010;55(4):1049\u201357.","journal-title":"Hypertension"},{"issue":"2","key":"1598_CR25","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1093\/jamia\/ocy143","volume":"26","author":"JL Belden","year":"2019","unstructured":"Belden JL, Wegier P, Patel J, et al. Designing a medication timeline for patients and physicians. J Am Med Inform Assoc. 2019;26(2):95\u2013105.","journal-title":"J Am Med Inform Assoc"},{"issue":"2","key":"1598_CR26","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1038\/ajh.2007.35","volume":"21","author":"J Fang","year":"2008","unstructured":"Fang J, Alderman MH, Keenan NL, Ayala C, Croft JB. Hypertension control at physicians\u2019 offices in the United States. Am J Hypertens. 2008;21(2):136\u201342.","journal-title":"Am J Hypertens"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01598-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-021-01598-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01598-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T09:04:47Z","timestamp":1628154287000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-021-01598-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,5]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1598"],"URL":"https:\/\/doi.org\/10.1186\/s12911-021-01598-4","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,5]]},"assertion":[{"value":"27 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The University of Missouri Health Sciences Institutional Review Board approved this study (#2002623). As the study was judged to be of minimal risk, the Institutional Review Board only required participants to provide verbal consent. Research staff explained the study to focus group participants, participants were verbally consented and provided with a printed copy of the study Waiver of Documentation of Consent form, and the verbal consent was documented on a study tracking sheet which was then securely stored.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"None to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"235"}}