(MEnD-AKI) Multicenter Implementation of an Electronic Decision Support System for Drug-associated AKI

摘要 在过去的八年里，美国的急性肾损伤（阿基）增加了38%，其中药物是主要原因。 住院患者中阿基的贡献者。药物相关阿基（D-AKI）导致严重后果， 大约40%的患者经历院内死亡或透析依赖，70%的患者 初始D-AKI事件后残留肾损伤的证据。我们发现很多病人 AKI高风险患者被发现较晚，并且经常继续接受肾毒性药物，直到阿基成为 严重。因此，我们设计了一个建议，以解决需要早期，适当的管理肾毒素 通过研究高级临床决策支持系统（CDSS）对原发性肝癌的影响， 旨在减少住院成人中的D-AKI。具体而言，我们的目标是：1）优化 由临床决策支持系统生成的D-AKI风险警报的临床性能; 2）测试 先进的临床决策支持系统加上药剂师主导的干预改善了短期和长期的， D-AKI患者的长期结局;以及3）确定医生对药剂师 性能、医生接受度和我们干预的成本效益。 2012年，改善肾脏疾病全球结局（KDIGO）发表了第一份全面的阿基临床研究报告。 实践指南。建议包括使用标准标准来定义和分期阿基， 对于所有患有阿基或有发生AKI风险的患者，应考虑一系列基于阶段的管理步骤。 然而，临床医生在采纳这些建议方面进展缓慢，一些团体（尤其是美国） KDOQI专家小组），虽然总体上支持该指南，但呼吁进行更多的研究测试， 建议.我们的建议通过测试一个独特的临床决策是否 识别高风险患者的支持系统，再加上针对 主治医生可以解决D-AKI和其他形式的阿基的药物给药，以改善患者护理。所以我们 中心目标是检查药剂师领导的干预对早期发现和管理的影响。 阿基、阿基进展和短期恢复以及各种AKI相关结局。

Abstract Acute Kidney Injury (AKI) in the US has increased by 38% over the last eight years, with drugs as a major contributor to AKI in hospitalized patients. Drug-associated AKI (D-AKI) results in severe consequences with approximately 40% of patients experiencing in-hospital death or dialysis dependence and 70% having evidence of residual kidney damage following the initial D-AKI event. We have determined that many patients at high risk for AKI are identified late and often continue to receive nephrotoxic drugs until AKI becomes severe. Thus, we designed a proposal to address the need for early, appropriate management of nephrotoxins in high-risk patients by studying the effect of an advanced clinical decision support system (CDSS) for primary physicians and hospitalists aimed at reducing D-AKI in hospitalized adults. Specifically, we aim to 1) optimize the clinical performance of D-AKI risk-alerts generated by a clinical decision support system; 2) test whether an advanced clinical decision support system coupled with a pharmacist-led intervention improves short and long- term outcomes for patients with D-AKI; and 3) determine physician perception of the pharmacists’ performance, physician acceptance and cost-effectiveness of our intervention. In 2012 Kidney Disease Improving Global Outcomes (KDIGO) published the first comprehensive AKI clinical practice guideline. Recommendations include the use of standard criteria for defining and staging AKI and a series of stage-based management steps to be considered for all patients with AKI or at risk for developing it. However, clinicians have been slow to adopt these recommendations and some groups (most notably the US KDOQI expert panel), while endorsing the guideline overall, have called for more research testing the recommendations. Our proposal directly addresses this concern by testing whether a unique clinical decision support system identifying high risk patients coupled with an advanced pharmacist service directed to the primary physician can address D-AKI and drug dosing for other forms of AKI to improve patient care. Thus, our central goal is to examine the effect of a pharmacist-led intervention on the early detection and management of AKI, progression of and short-term recovery from AKI, and on various AKI-related outcomes.