Improving Chronic Disease Management with Pieces (ICD-Pieces)

用饮片改善慢性病管理（ICD-饮片）

基本信息

批准号：
8777866
负责人：
MIGUEL A VAZQUEZ
金额：
$ 78.49万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-22 至 2015-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8777866
关键词：
Address Adoption Adult African American Cardiac Death Cardiovascular system Caring Cessation of life Chronic Chronic Disease Chronic Kidney Failure Clinical Clinical Trials Clinical Trials Design Collaborations Communities Computer software Connecticut Data Diabetes Mellitus Diagnosis Disease Management Disease Progression Electronic Health Record End stage renal failure Ensure Evaluation Event Future Goals Guidelines Health Health Resources Healthcare Systems Heart Heart Arrest Heart failure Hispanics Home environment Hospitalization Hospitals Human Subject Research Hypertension Information Technology Intensive Care Units Intervention Kidney Diseases Lead Location Medical Minority Modeling Monitor Morbidity - disease rate National Institute of Diabetes and Digestive and Kidney Diseases Nephrology Outcome Patient Care Patients Phase Physicians Population Population Heterogeneity Preparation Prevalence Primary Care Physician Primary Health Care Public Health Publishing Randomized Randomized Clinical Trials Research Resources Risk Site System Technology Testing Texas Translating Triad Acrylic Resin United States United States National Institutes of Health Veterans blood pressure regulation clinical practice clinically relevant collaborative care collaboratory computerized data processing cost effective therapy experience improved innovation member mortality multiple chronic conditions new technology novel organizational structure patient population pragmatic trial public health relevance socioeconomics success

项目摘要

DESCRIPTION (provided by applicant): The growing number of patients who have chronic kidney disease (CKD), diabetes and hypertension is a public health challenge. CKD, diabetes and hypertension are 3 chronic medical conditions (CMCs) that increase morbidity, mortality, resource utilization and costs. Among adults in the United States the prevalence of CKD has increased from 10 to 14% over the past two decades and diabetes and hypertension are the 2 leading causes of CKD and end-stage renal disease. Important progress in identification of effective treatments for CKD, diabetes and hypertension has been made but there is a significant gap in translating these treatments to clinical practice. We have recently implemented a collaboratory primary care and nephrology care model at Parkland Health and Hospital System for patients with CKD in a predominantly minority population using a novel technology platform (Pieces- Parkland intelligent e-coordination and evaluation system) that allows us to leverage information from the electronic health record (EHR) to facilitate implementation of CKD care within primary care practices and medical homes in the community. In a study supported by NIDDK we are already observing improvements in BP control with a collaborative care model using Pieces to identify people with CKD and assist implementing recommended practices. We have also used Pieces to successfully develop various risk prediction models for readmissions and deaths in collaborating large health care systems. We now propose a randomized pragmatic trial, Improving Chronic Disease Management with Pieces (ICD-Pieces), in 4 large health care systems to test our model of care for patients with multimorbidity. The main hypothesis is that patients with CKD, hypertension and diabetes who receive care with a collaborative model of primary care-subspecialty care enhanced by novel information technology (Pieces) will have fewer hospitalizations, readmissions, CV events and deaths than patients receiving standard medical care. During the planning phase (UH2) we will establish the collaboratory and complete preparations at all participating sites for the study. In the implementation phase (UH3) we will conduct the randomized clinical trial pragmatic trial across the 4 large health care systems in the collaboratory. Our trial is pragmatic and randomized with rigorous controls and tests the implementation of several accepted and well-characterized interventions which will be coordinated and applied broadly to patients with CKD, hypertension and diabetes to evaluate clinically relevant outcomes. Our study has clearly defined milestones. The 4 participating large health care systems have different organizational structures, utilize different EHR and serve very different patient populations. We anticipate that findings from our study will provide a framework for future clinical trials and to advance the care of patients with multiple chronic medical conditions.

描述（由申请人提供）：越来越多的患有慢性肾脏疾病（CKD），糖尿病和高血压的患者是公共卫生挑战。 CKD，糖尿病和高血压是3种慢性病（CMC），可提高发病率，死亡率，资源利用和成本。在美国的成年人中，CKD的患病率在过去的二十年中从10％增加到14％，而糖尿病和高血压是CKD和终末期肾脏疾病的两个主要原因。在鉴定有效治疗CKD，糖尿病和高血压的有效治疗方法方面的重要进展已经取得长足，但是将这些治疗方法转化为临床实践存在很大的差距。我们最近在Parkland Health and Hospital System在Parkland Health and Hospital System中为CKD患者实施了一个合作的初级保健和肾脏病医生模型，主要是使用新型技术平台（Priep-Parkland智能电子协调和评估系统），这使我们能够从电子健康记录（EHR）中利用信息，以促进基本医疗惯例和医疗习惯中的CKD护理。在NIDDK支持的一项研究中，我们已经通过使用合作护理模型来观察BP控制的改进，该模型使用零件来识别具有CKD的人并协助实施推荐实践。我们还使用部分成功地开发了各种风险预测模型，以在合作的大型医疗保健系统中进行再入院和死亡。现在，我们提出了一项随机务实的试验，在4个大型医疗保健系统中改善了慢性病管理（ICD-PIECES），以测试我们针对多种多发性患者的护理模型。主要的假设是，通过新型信息技术（零件）增强的初级护理 - 掩体护理的协作模型，接受CKD，高血压和糖尿病患者的住院治疗，复习，CV事件和死亡的率将比接受标准医疗的患者更少。在计划阶段（UH2）期间，我们将在所有参与的网站上建立合作和完整的准备工作。在实施阶段（UH3），我们将在协作中的4个大型医疗保健系统中进行随机临床试验。我们的试验是务实的，并随机进行严格的控制，并测试了几种接受且特征良好的干预措施的实施，这些干预措施将与CKD，高血压和糖尿病患者大致应用，以评估与临床相关的结果。我们的研究明确定义了里程碑。这4个参与的大型医疗保健系统具有不同的组织结构，利用不同的EHR并为不同的患者人群提供服务。我们预计我们的研究结果将为将来的临床试验提供一个框架，并提高患有多种慢性医疗状况的患者的护理。