Health IT Enhanced for CKD in Safety-Net Primary Care

安全网初级保健中针对 CKD 的健康 IT 增强

• 批准号: 8335416
• 负责人: NEIL R. POWE
• 金额: $ 23.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 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 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8335416
• 关键词: Address; Adoption; Adult; Albuminuria; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Awareness; Blood Pressure; Cardiovascular system; Caring; Chronic; Chronic Disease; Chronic Kidney Failure; Clinic; Clinical; Clinical Trials; Communication; Community Health; Complex; Computers; Decision Making; Diabetes Mellitus; Disease; Disease Management; Disease Progression; Education; Educational Materials; Environment; Epidemic; Excess Mortality; Feedback; Fostering; Glomerular Filtration Rate; Glycosylated hemoglobin A; Goals; Grant; Health; Health Communication; Health Status; Health system; Healthcare Systems; Hypotension; Information Technology; Institution; Intervention; Knowledge; Knowledge Discovery; Life Style; Maintenance; Metabolic; Minority; Morbidity - disease rate; Notification; Outcome; Patients; Peptidyl-Dipeptidase A; Population; Primary Health Care; Program Sustainability; Provider; Randomized; Registries; Research; Research Design; Resources; Risk Reduction Behavior; Self Management; System; Telephone; Testing; Translating; Underserved Population; United States; Ursidae Family; Vulnerable Populations; Work; base; blood pressure regulation; burden of illness; chronic care model; disease registry; evidence base; evidence based guidelines; experience; follow-up; health care delivery; health information technology; health literacy; high risk; improved; kidney disease education; mortality; patient population; prevent; primary outcome; programs; prospective; randomized trial; research study; response; safety net; social cognitive theory; successful intervention; therapy adherence; treatment strategy

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) is common in U.S. adults and is associated with excess mortality and morbidity. Better management could slow progression of disease, prevent metabolic complications, and reduce cardiovascular outcomes. However, low patient and provider awareness of CKD, inadequate knowledge of treatment strategies, and ineffective patient-provider communication can impede such efforts. We propose to evaluate an incrementally intensive set of interventions to enhance awareness, improve knowledge, and foster better communication, possibly leading to better clinical outcomes. The interventions, based on the Chronic Care Model and Social Cognitive Theory, will be evaluated in a high-risk, underserved population seeking primary care at 10 community health clinics, using a prospective randomized trial nested in a quasi- experimental study design. In four clinics, we will introduce an automated CKD registry incorporating decision support, which will identify patients with CKD, send notifications to providers, and provide educational materials to patients and providers (Basic CKD Registry). In six additional clinics, we will introduce the Enhanced CKD Registry, which will include all the components of the Basic CKD Registry, augmented with claims-based surveillance of care and care team feedback. We will randomize patients in these six clinics to either 1) the Enhanced CKD Registry intervention or 2) the Enhanced CKD Registry Plus, which includes an additional patient-level intervention: automated telephone calls offering CKD education and self-management support, with need-based follow-up by a health coach who communicates with the care team. We will compare our primary outcome, change in blood pressure, pre- vs. post-implementation of the Basic CKD Registry; between patients in the Enhanced vs. Basic CKD Registry; and between patients in the Enhanced CKD Registry Plus vs. the Enhanced CKD Registry. We will also examine secondary clinical (e.g., albuminuria, HbA1c), intermediate (e.g., awareness, activation, ACE/ARB use), and sustainability (e.g., reach, adoption, maintenance) outcomes. This proposal unites a large safety-net health system for patients at high risk for CKD progression and complications to address barriers to improved CKD management. Successful interventions can be extended throughout our larger healthcare system, on a wider scale in similar safety-net systems, and in patient populations with less complex clinical profiles. Thus, this study has important implications for improving the health status of CKD patients in the United States.

描述（由申请人提供）：慢性肾脏疾病（CKD）在美国成年人中很常见，并与过度死亡率和发病率相关。更好的管理可以减缓疾病的进展，预防代谢并发症，减少心血管疾病的发生。然而，患者和提供者对CKD的认识不足，治疗策略知识不足以及患者与提供者沟通不力可能会阻碍这些努力。我们建议评估一套增量密集的干预措施，以提高认识，提高知识，促进更好的沟通，可能会导致更好的临床结果。基于慢性病护理模式和社会认知理论的干预措施将在10个社区卫生诊所寻求初级保健的高风险，服务不足的人群中进行评估，使用嵌套在准实验研究设计中的前瞻性随机试验。在四个诊所中，我们将引入一个包含决策支持的自动化CKD登记系统，该系统将识别CKD患者，向提供者发送通知，并向患者和提供者提供教育材料（基本CKD登记系统）。在另外六家诊所，我们将引入增强型CKD登记系统，该系统将包括基本CKD登记系统的所有组成部分，并增加基于索赔的护理监测和护理团队反馈。我们将在这六个诊所中随机分配患者接受1）增强型CKD登记干预或2）增强型CKD登记+，其中包括额外的患者水平干预：提供CKD教育和自我管理支持的自动电话呼叫，由与护理团队沟通的健康教练进行基于需求的随访。我们将比较我们的主要结局，血压变化，实施基础CKD登记研究前后;增强型CKD登记研究与基础CKD登记研究中的患者之间;增强型CKD登记研究+与增强型CKD登记研究中的患者之间。我们还将检查次要临床（例如，白蛋白尿，HbA 1c），中间（例如，意识、激活、ACE/ARB使用）和可持续性（例如，达到，采用，维护）的结果。该提案为CKD进展和并发症高风险患者建立了一个大型安全网卫生系统，以解决改善CKD管理的障碍。成功的干预措施可以在我们更大的医疗保健系统中推广，在类似的安全网系统中推广，在临床特征不太复杂的患者群体中推广。因此，这项研究对改善美国CKD患者的健康状况具有重要意义。