Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD)
Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD)
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DOI：
10.3122/jabfm.2016.05.160020
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发表时间：
2016-09-01
影响因子：
2.9
通讯作者：
Ornstein, Steven M.
中科院分区：
文献类型：
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作者：
Litvin, Cara B.;Hyer, J. Madison;Ornstein, Steven M.
背景资料：慢性肾脏病（CKD）的早期检测可以导致干预措施，以预防肾衰竭和降低心血管疾病的风险，但坚持治疗目标是次优的初级保健环境。本研究的目的是评估临床决策支持（CDS）是否可以用来提高CKD.Methods的识别和管理：这2年的示范研究进行了11初级保健PPRNet的做法。CDS包括风险评估工具、健康维护协议、流程图和患者登记。实践收到的性能报告，并主办每年半天onsitevisit.Results：有统计学显着增加筛查白蛋白尿（中位数24个月变化30%，p < 0.0005）和监测白蛋白尿（中位数24个月变化25%，p < 0.0005）。适当使用ACE抑制剂或血管紧张素受体阻滞剂的绝对改善23.5%和血红蛋白测量的绝对改善7.0%没有统计学显著性。其他CKD CQM无临床或统计学显著差异。CDS使用的促进因素包括实践中优先考虑改善CKD和工作人员使用长期订单。障碍包括将使用纳入现有的工作流程和变量之间的使用providers.Conclusions：使用CDS，以改善CKD的识别和管理，在初级保健的做法显示出的承诺。然而，必须解决其他障碍，以有效地实现CKD结局的改善。
Background: Early detection of chronic kidney disease (CKD) can lead to interventions to prevent renal failure and reduce risk for cardiovascular disease, yet adherence to treatment goals is suboptimal in the primary care setting. The purpose of this study was to assess whether clinical decision support (CDS) can be used to improve the identification and management of CKD.Methods: This 2 year demonstration study was conducted in 11 primary care PPRNet practices. CDS included a risk assessment tool, health maintenance protocols, flow chart and a patient registry. Practices received performance reports and hosted annual half day on-site visits.Results: There were statistically significant increases in screening for albuminuria (median 24 month change 30%, p < 0.0005) and monitoring albuminuria (median 24 month change 25%, p < 0.0005). An absolute 23.5% improvement in appropriate use of ACE-inhibitor or angiotensin receptor blocker and an absolute 7.0% improvement in hemoglobin measurement were not statistically significant. There were no clinical or statistically significant differences in other CKD CQMs. Facilitators to CDS use included practices' prioritization of improving CKD and staff use of standing orders. Barriers included incorporating use into existing workflow and variable use among providers.Conclusions: Use of CDS to improve CKD identification and management in primary care practices shows promise. However, other barriers must be addressed to effectively achieve improvements in CKD outcomes.