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Game changer: Patients of doctors who played online game had better control of blood pressure

Boston, MA Primary care providers who engaged in an online game to solve clinical cases about hypertension management improved blood pressure control of their patients in a shorter amount of time compared to non-gamers, according to a new study by researchers at Brigham and Women's Hospital (BWH) and the Veterans Affairs Boston Healthcare System.

The study was published May 20, 2014 in Circulation: Cardiovascular Quality and Outcomes.

"This study is the first to show that an online educational game among medical professionals can improve the health measures of their patients," said Alexander Turchin, MD, MS, director of Informatics Research, BWH Division of Endocrinology, co-lead study author.

Leveraging spaced education, a learning concept in which students may significantly increase knowledge retention if information is presented and reinforced over spaced intervals of time, researchers found that primary care clinicians who participated in an online spaced-education game developed by B. Price Kerfoot, MD, EdM, staff surgeon, Veterans Affairs Boston Healthcare System, lead study author, improved their knowledge of managing high blood pressure and generated a modest but significant decrease in the time it took for their patients with high blood pressure to reach their blood pressure target.

A two-arm, randomized trial was conducted during the course of a little over a year among primary care clinicians at eight Veterans Affairs hospitals in the Northeast United States. Clinicians were randomized to either a group that received educational content about lowering blood pressure in the form of an online game vs. a group who received identical content via a static online posting. One hundred eleven clinicians enrolled in the study. Of those enrolled, 48 completed the trivia game while 47 completed the readings of the online posting.

Educational content consisted of 32 validated clinical cases followed by multiple-choice questions with explanations on hypertension management. Those in the online game group were e-mailed one question every three days. Questions were re-sent in 12 or 24 days if answered incorrectly or correctly, respectively. A question was retired when clinicians answered it correctly twice consecutively. The game would post clinician scores to foster competition.

Primary outcome measured was time to reach blood pressure target (less than 140/90 mm Hg). In multivariable analysis of 17,866 hypertensive periods among 14,336 patients, the researchers observed a modest decrease in the time to achieve target blood pressure values in patients treated by clinicians in the online game group.

Researchers found that patients of clinicians playing the game lowered their blood pressure to their target level in 142 days compared to 148 days for those whose clinicians read an online posting.

The number of clinicians who had to participate in the game to achieve target blood pressure in one more patient was 0.43 (i.e., for every four clinicians who participated in the game, approximately 10 more patients achieved target blood pressure).

According to the researchers, anyone can enroll in the spaced-education game for free at Qstream (, a start-up company launched by Harvard to develop and disseminate the spaced-education methodology outside of its firewalls.

"Based on our findings, educational games may be effective tools to engage health professionals, boost learning, optimize practice patterns, and improve patient outcomes," said Turchin. "We hope that future studies continue to focus on figuring out how to most effectively integrate games into the education of health professionals for the benefit of their patients."


Contact: Marjorie Montemayor-Quellenberg
Brigham and Women's Hospital

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