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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：
9557797
负责人：
MIGUEL A VAZQUEZ
金额：
$ 5万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-01 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9557797
关键词：
Address Adoption Adult African American Cardiac Death Cardiovascular system Caring Cessation of life Chronic Chronic Disease Chronic Kidney Failure Chronic Phase Clinical Clinical Trials Collaborations Communities Computer software Connecticut Data Diabetes Mellitus Diagnosis Disease Management Disease Progression Electronic Health Record End stage renal failure Enhancement Technology 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 Patient-Focused Outcomes Patients Phase Physicians Population Population Heterogeneity Preparation Prevalence Primary Care Physician Primary Health Care Process Public Health Publishing Randomized Randomized Clinical Trials Research Resources 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 cost effective therapy experience improved innovation member mortality multiple chronic conditions new technology novel organizational structure outcome prediction patient population pragmatic trial predictive modeling public health relevance socioeconomics success trial design

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）：患有慢性肾脏疾病（CKD）、糖尿病和高血压的患者数量不断增加，这是一项公共卫生挑战。CKD、糖尿病和高血压是增加发病率、死亡率、资源利用和成本的3种慢性医学病症（CMC）。在美国的成人中，CKD的患病率在过去二十年中从10%增加到14%，糖尿病和高血压是CKD和终末期肾病的两个主要原因。在确定CKD、糖尿病和高血压的有效治疗方法方面取得了重要进展，但在将这些治疗方法转化为临床实践方面存在重大差距。我们最近在帕克兰健康和医院系统实施了一个合作实验室初级保健和肾脏病护理模式，用于主要为少数民族人群的CKD患者（Pieces-帕克兰智能电子协调和评估系统），使我们能够利用电子健康记录（EHR）中的信息促进在社区的初级保健实践和医疗之家实施CKD护理。在NIDDK支持的一项研究中，我们已经观察到使用Pieces的协作护理模式在BP控制方面的改善，以识别CKD患者并协助实施推荐的实践。我们还使用Pieces成功开发了各种风险预测模型，用于协作大型医疗保健系统的再入院和死亡。我们现在提出了一项随机化的实用试验，在4个大型医疗保健系统中使用碎片改善慢性病管理（ICD碎片），以测试我们对多Morphine患者的护理模式。主要假设是CKD、高血压和糖尿病患者接受由新型信息技术（Pieces）增强的初级护理-专科护理协作模式的护理，与接受标准医疗护理的患者相比，住院、再入院、CV事件和死亡较少。在计划阶段（UH 2），我们将在所有参与研究的研究中心建立合作实验室并完成准备工作。在实施阶段（UH 3），我们将在合作实验室的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，随机的，有严格的对照，并测试了几种公认的和充分表征的干预措施的实施，这些干预措施将被协调并广泛应用于CKD，高血压和糖尿病患者，以评估临床相关的结果。我们的研究明确界定了里程碑。参与的4个大型医疗保健系统具有不同的组织结构，使用不同的EHR，并为非常不同的患者群体提供服务。我们预计，我们的研究结果将为未来的临床试验提供一个框架，并促进对多种慢性疾病患者的护理。