Improving CKD Detection and Care in a High Risk Underserved Population

改善服务不足的高危人群的 CKD 检测和护理

• 批准号: 8233901
• 负责人: MIGUEL A VAZQUEZ
• 金额: $ 33.96万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8233901
• 关键词: African American; Albumins; Albuminuria; Bicarbonates; Blood Vessels; Caring; Catheters; Chronic Kidney Failure; Clinic; Clinical; Clinical Management; Communities; Computerized Medical Record; County; Detection; Dialysis procedure; Early Diagnosis; Education; Enrollment; Evaluation; Evidence based intervention; Glycosylated hemoglobin A; Goals; Health; Hispanics; Home environment; Hospitalization; Hospitals; ICD-9; Information Technology; Institution; Integrated Delivery of Health Care; Integrated Health Care Systems; Intervention; Joints; Kidney; Kidney Diseases; Kidney Transplantation; Knowledge; Lead; Living Donors; Measures; Medical; Medical Records; Minority; Minority Groups; Modality; Modeling; Monitor; National Committee for Quality Assurance; Nephrology; Outcome; Patient Monitoring; Patients; Peritoneal Dialysis; Phosphorus; Population; Preparation; Primary Health Care; Proteinuria; Protocols documentation; Public Health; Renal Replacement Therapy; Reporting; Risk Factors; System; Teaching Hospitals; Time; Transplantation; Underserved Population; United States; Venous; blood pressure regulation; care systems; cost; diabetic; evidence based guidelines; health information technology; high risk; improved; insight; member; mortality; multidisciplinary; novel; novel strategies; patient population; primary outcome; programs; secondary outcome

DESCRIPTION (provided by applicant): The growing number of patients with chronic kidney disease (CKD) is a public health challenge. Several interventions have been proven to be effective in improving outcomes for patients with CKD, but many patients do not receive these therapies. The gap between advances in knowledge of how to treat CKD and implementation of optimal care is especially large for members of certain ethnic and racial minorities and underserved populations. The main goal of this proposal is to improve the care of all patients with CKD and to develop strategies that may prove to be particularly effective in high risk underserved populations. Our main teaching hospital, Parkland Health and Hospital Systems (PHHS), cares for the underserved in Dallas County and serves a predominantly African-American and Hispanic population. PHHS has a network of primary care clinics distributed throughout the community and designated as Medical Homes. PHHS has a fully operational IT-enabled program, the Parkland Intelligent e- Coordination and Evaluation System (PIECES), that facilitates harnessing the electronic medical record to implement, coordinate and monitor evidence-based interventions in our patient population. The main hypothesis of this proposal is that a new model of joint primary care-nephrology care will improve clinical management of risk factors for progression of CKD and CV complications in patients with chronic kidney disease. We also propose that the application of a novel health information technology platform will allow earlier detection of CKD in African-American and Hispanic patient populations and facilitate CKD care and preparation for renal replacement therapy. The first specific aim is to improve detection of CKD in the high risk predominantly minority population served at PHHS. The second specific aim is to implement interventions proven to slow the progression of CKD and treat associated conditions. The third specific aim is to prepare patients for optimal initiation o renal replacement therapy including preparation for transplantation and if dialysis is needed, timely modality selection, access placement and avoiding temporary central venous catheters. Successful application of this collaborative primary care/nephrology model of care which incorporates new health information technology has the potential to improve the care not only for minority patients in our institution for all CKD patients in the United States. PUBLIC HEALTH RELEVANCE: Chronic kidney disease (CKD) is a common medical problem that leads to higher mortality, hospitalizations, and costs. Many patients do not receive treatments proven to help slow the progression of kidney disease and its complications. This study is directed to improving the care of CKD patients especially for those in minority populations that are at the highest risk.

描述（由申请人提供）：越来越多的慢性肾脏疾病患者（CKD）是公共卫生挑战。事实证明，几种干预措施可有效改善CKD患者的预后，但许多患者未接受这些疗法。对于某些种族和种族少数民族和服务不足的人群的成员，知识如何治疗CKD的知识和实施最佳护理的实施之间的差距尤其很大。该提案的主要目标是改善所有CKD患者的护理，并制定可能在高风险不足的人群中特别有效的策略。 我们的主要教学医院，Parkland Health and Hospital Systems（PHHS）关心在达拉斯县服务不足的人，并为非裔美国人和西班牙裔人口服务。 PHHS拥有一个在整个社区中分布的初级保健诊所网络，并被指定为医疗家园。 PHHS具有完全支持IT的计划，即Parkland Intelligent Esodination and评估系统（零件），可利用电子病历来实施，协调和监控我们患者人群的基于证据的干预措施。 该提案的主要假设是，一种新的一级护理妇科护理模型将改善慢性肾脏疾病患者中CKD和CV并发症的危险因素的临床管理。我们还建议，新型健康信息技术平台的应用将允许在非裔美国人和西班牙裔患者人群中早期发现CKD，并促进CKD护理并准备肾脏替代疗法。第一个具体目的是改善在PHHS的高风险中对CKD的检测。第二个具体目的是实施被证明降低CKD进展并治疗相关条件的干预措施。第三个具体目的是为患者做好最佳启动O肾脏替代疗法的准备，包括进行移植准备和如果需要透析，及时选择，访问和避免临时的中央静脉导管。 该协作的初级保健/肾脏病学模型成功地应用了新的健康信息技术，不仅可以为美国所有CKD患者的少数族裔患者改善护理。 公共卫生相关性：慢性肾脏疾病（CKD）是一个常见的医学问题，导致死亡率更高，住院和费用。许多患者未接受治疗，证明有助于减缓肾脏疾病及其并发症的进展。这项研究旨在改善CKD患者的护理，特别是对于少数族裔风险最高的人的护理。