A Risk Based Approach to Improving Management of Chronic Kidney Disease

基于风险的方法改善慢性肾脏病的管理

• 批准号: 7941071
• 负责人: THOMAS D SEQUIST
• 金额: $ 39.14万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941071
• 关键词: Risk; Based; Approach; Improving; Management

DESCRIPTION (provided by applicant): Chronic kidney disease affects over 25 million Americans and is associated with significant patient morbidity and mortality, as well as high health care costs. Primary care represents the front line in the early identification and management of chronic kidney disease. Unfortunately, this disease remains unrecognized, both by primary care physicians and their patients; leading to suboptimal quality of care and poor health outcomes. This study will evaluate electronic alerts to risk stratify patients with chronic kidney disease and present targeted treatment recommendations to primary care physicians within an electronic health record. The intervention will take place at Harvard Vanguard Medical Associates, a large multispecialty group practice consisting of 14 health centers in eastern Massachusetts. With a randomized, controlled study design, the study has three specific aims: 1) To use computerized clinical information systems to identify baseline predictors of appropriate evaluation and treatment of Stages 3 and 4 chronic kidney disease, including patient characteristics and nephrology involvement 2) To assess whether quality of care for stage 3 chronic kidney disease can be substantially improved over 18 months by the combination of a) point of care electronic alerts to primary care physicians recommending risk-appropriate care, and b) quarterly mailings to patients providing self management support materials 3) To assess the relationship between utilization of the intervention components and primary care physician attitudes towards chronic kidney disease management and electronic reminder systems. This study has important implications for how the treatment of outpatients with chronic kidney disease can be optimized in the primary care setting. In doing this, it will provide a model for how ambulatory practices across the country can use health information technology and electronic health records to risk stratify large patient populations with chronic disease, and combine both point-of-care alerts with patient outreach in an efficient manner.

描述（由申请人提供）：慢性肾脏疾病影响超过2500万美国人，并与显著的患者发病率和死亡率以及高医疗保健成本相关。初级保健是早期识别和管理慢性肾脏疾病的前沿。不幸的是，这种疾病仍然没有得到认识，无论是初级保健医生和他们的医生。 患者;导致护理质量不佳和健康结果不佳。这项研究将评估电子警报，以对慢性肾脏疾病患者进行风险分层，并在电子健康记录中向初级保健医生提供有针对性的治疗建议。干预将在哈佛先锋医疗协会进行，这是一个大型的多专业团体实践，由马萨诸塞州东部的14个健康中心组成。通过随机对照研究设计，该研究有三个具体目标： 1)使用计算机化临床信息系统确定3期和4期慢性肾脏病适当评估和治疗的基线预测因素，包括患者特征和肾脏受累情况 2)评估3期慢性肾脏疾病的护理质量是否可以通过以下两种方式在18个月内得到实质性改善：a）向初级保健医生提供即时电子警报，建议风险适当的护理，和B）向患者每季度邮寄一次，提供自我管理支持材料 3)评估干预成分的使用与初级保健医生对慢性肾脏疾病管理和电子提醒系统的态度之间的关系。 这项研究对于如何在初级保健环境中优化慢性肾脏病门诊患者的治疗具有重要意义。在这样做的过程中，它将提供一个模型，说明全国各地的流动实践如何使用健康信息技术和电子健康记录来对患有慢性病的大量患者人群进行风险分层，并以有效的方式将护理点警报与患者外展联合收割机结合起来。