Navigating the Challenges of Chronic Kidney Disease

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DESCRIPTION (provided by applicant): Our long term objective related to this project is to develop, demonstrate and promote widespread implementation of support approaches for patients and care providers that optimize chronic kidney disease (CKD) patients' adherence to the best available disease management regimen. CKD is a large and costly public health problem in the U.S. that will continue to grow with the aging of the population and increasing incidences of obesity, hypertension and diabetes. Although evidence-based treatments and self-management regimens are available that are effective in slowing progression of CKD to end-stage renal disease, inadequate awareness and coordination among patients and primary care providers has prevented widespread implementation of those approaches. For this planning grant, we propose to conduct a clinical trial to test two interactive informational approaches to improving chronic care and ultimately outcomes of CKD patients. Both approaches will follow the well-established chronic care model to improve CKD outcomes for CKD Stage 3b/4 patients. In Specific Aim 1, we will adapt the model of individual patient navigators employed successfully in the oncology field to create a CKD Patient Navigator program to promote adherence to the chronic care regimen. We hypothesize that a CKD Patient Navigator program will produce a more prepared, proactive patient-caregiver group than usual care. In Specific Aim 2, we will work with our existing electronic health record-based personal health record (PHR) and enhance it to use electronic communication to disseminate CKD education and stage-specific goals of care for CKD Stage 3b/4 patients. We hypothesize that an enhanced PHR will result in a more informed, activated patient than usual care. In Specific Aim 3, we will conduct a prospective randomized clinical trial using a factorial design to investigate the clinical impact and cost-effectiveness of the two interventions described in Specific Aims 1 and 2 for patients with stage 3b or stage 4 CKD. Two hundred and eight patients will be recruited for the trial from among nearly 18,000 patients with stage 3b/4 CKD identified in the Cleveland Clinic Health Systems EHR-based CKD Registry developed and validated by us. We hypothesize that patients in the patient navigator arm and those in the enhanced PHR arm will have a slower rate of decline in estimated glomerular filtration rate than patients receiving only usual care. The results of this study will lay the foundation for a larger multi-center national clinical trial tha will build upon the feasibility and knowledge gained from this planning grant to work towards translating effective interventions into routine clinical practice and ultimately improving the car of those with CKD.