An online spaced-education game among clinicians improves their patients' time to blood pressure control: a randomized controlled trial

Circ Cardiovasc Qual Outcomes. 2014 May;7(3):468-74. doi: 10.1161/CIRCOUTCOMES.113.000814.


Background: Many patients with high blood pressure (BP) do not have antihypertensive medications appropriately intensified at clinician visits. We investigated whether an online spaced-education (SE) game among primary care clinicians can decrease time to BP target among their hypertensive patients.

Methods and results: A 2-arm randomized trial was conducted over 52 weeks among primary care clinicians at 8 hospitals. Educational content consisted of 32 validated multiple-choice questions with explanations on hypertension management. Providers were randomized into 2 groups: SE clinicians were enrolled in the game, whereas control clinicians received identical educational content in an online posting. SE game clinicians were e-mailed 1 question every 3 days. Adaptive game mechanics resent questions in 12 or 24 days if answered incorrectly or correctly, respectively. Clinicians retired questions by answering each correctly twice consecutively. Posting of relative performance among peers fostered competition. Primary outcome measure was time to BP target (<140/90 mm Hg). One hundred eleven clinicians enrolled. The SE game was completed by 87% of clinicians (48/55), whereas 84% of control clinicians (47/56) read the online posting. In multivariable analysis of 17 866 hypertensive periods among 14 336 patients, the hazard ratio for time to BP target in the SE game cohort was 1.043 (95% confidence interval, 1.007-1.081; P=0.018). The number of hypertensive episodes needed to treat to normalize one additional patient's BP was 67.8. The number of clinicians needed to teach to achieve this was 0.43.

Conclusions: An online SE game among clinicians generated a modest but significant reduction in the time to BP target among their hypertensive patients.

Clinical trial registration url: Unique identifier: NCT00904007.

Keywords: educational technology; health services research; hypertension; medical education; patients.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Audiovisual Aids / statistics & numerical data
  • Decision Making, Computer-Assisted
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / drug therapy
  • Hypertension / epidemiology*
  • Male
  • Middle Aged
  • Online Systems / statistics & numerical data*
  • Physicians, Primary Care / statistics & numerical data*
  • Quality Improvement
  • Time Factors
  • Treatment Outcome
  • United States
  • Video Games / statistics & numerical data*


  • Antihypertensive Agents

Associated data