A Risk Based Approach to Improving Management of Chronic Kidney Disease

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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.