To describe the prevalence of blood pressure (BP) screening according to the 2017 American Academy of Pediatrics (AAP) guidelines and differences according to social vulnerability indicators.
We extracted electronic health record data from January 1, 2018, through December 31, 2018 from the largest healthcare system in Central Massachusetts. Outpatient visits for children 3 to 17 years without a prior hypertension diagnosis were included. Adherence was defined by the AAP guideline (≥1 BP screening for children with a body mass index [BMI] <95%) and at every encounter for children with a BMI ≥95%). Independent variables included social vulnerability indicators at the patient level (insurance type, language, Child Opportunity Index, race/ethnicity) and clinic level (location, Medicaid population). Covariates included child's age, sex, and BMI status, and clinic specialty, patient panel size, and number of healthcare providers. We used direct estimation to calculate prevalence estimates and multivariable mixed effects logistic regression to determine the odds of receiving guideline adherent BP screening.
Our sample comprised 19,695 children (median age 11 years, 48% female) from 7 pediatric and 20 family medicine clinics. The prevalence of guideline adherent BP screening was 89%. In our adjusted model, children with a BMI ≥95%, with public insurance, and who were patients at clinics with larger Medicaid populations and larger patient panels had lower odds of receiving guideline adherent BP screening.
Despite overall high adherence to BP screening guidelines, patient- and clinic-level disparities were identified.

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