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Evaluating the Impact of Guidelines on Physician Prescription Practices in Chronic Kidney Disease

评估慢性肾脏病医生处方实践指南的影响

基本信息

批准号：
9975628
负责人：
Chi Chu
金额：
$ 7.37万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9975628
关键词：
Address Age American American Heart Association Atherosclerosis Awareness Behavior Biometry California Cardiology Cardiovascular Diseases Cardiovascular system Caring Chronic Kidney Failure Clinical Practice Guideline Clinical Research Cross-Sectional Studies Data Data Set Databases Development Electronic Health Record Elements Enrollment Equation Evaluation Event Evidence based treatment Fibrinogen Frequencies Funding General Population Glomerular Filtration Rate Goals Guidelines Health Health system Healthcare Systems Hydroxymethylglutaryl-CoA Reductase Inhibitors Individual Instruction Interruption Intervention K-Series Research Career Programs Kidney Kidney Diseases Knowledge Lipids Morbidity - disease rate National Health and Nutrition Examination Survey Nephrology Outcome Patient Care Patients Perception Physicians Population Prevalence Preventive Primary Health Care Provider Public Health Publishing Recommendation Research Design Risk Assessment Risk Management Risk Reduction San Francisco Science Serum Societies Survey Methodology Surveys System Time Series Analysis Time trend Universities Update Visit base cardiovascular disorder risk cardiovascular risk factor care delivery care providers cohort college design effective intervention evidence base health care delivery implementation strategy improved insight low socioeconomic status medical specialties mortality population based programs research study

项目摘要

ABSTRACT Cardiovascular disease is the leading cause of morbidity and mortality among individuals with chronic kidney disease (CKD). Despite evidence and clinical practice guidelines supporting the use of statins for cardiovascular risk reduction in non-dialysis requiring chronic kidney disease, prevalence of statin prescription among individuals with CKD remains low. Strategies to increase statin use represent an important opportunity to improve cardiovascular outcomes for this population. Reasons underlying the current low rates of statin use remain unclear, thus elucidating these reasons will be important for informing the design of successful implementation strategies. The specific aims of this proposal are intended to examine different factors that influence rates of statin prescription among individuals with CKD. Aim 1 will assess the impact of changes in clinical practice guidelines by examining temporal trends in statin use among individuals with CKD using a nationally representative database. Aims 2 and 3 will examine more granular provider-level factors that may influence statin prescription (i.e., the contribution of nephrology care to cardiovascular risk management, primary care provider (PCP) knowledge of preventive cardiovascular care guidelines, PCP perception of cardiovascular risk in CKD patients) and correlate them with individual practice behaviors, using data from the San Francisco Health Network, a local public health system that disproportionately cares for individuals of low socioeconomic status. The study design will involve cross-sectional analyses of both a large national dataset (the National Health and Nutrition Examination Survey; NHANES) for Aim 1 and a local dataset from the electronic health record of one health delivery system (San Francisco Health Network) for Aims 2 and 3. Aim 3 will also involve a survey of local primary care providers to assess awareness of guidelines and perceptions of cardiovascular risk pertinent to CKD patients.

摘要心血管疾病是慢性肾脏病患者发病和死亡的主要原因病（CKD）。尽管有证据和临床实践指南支持使用他汀类药物，需要非透析的慢性肾病患者心血管风险降低，他汀类处方的流行率 CKD患者的发病率仍然很低。增加他汀类药物使用的策略是一个重要的机会以改善该人群的心血管结局。目前他汀类药物使用率低的原因仍然不清楚，因此阐明这些原因对于为成功的设计提供信息非常重要执行战略。该提案的具体目标是检查影响他汀类药物使用率的不同因素 CKD患者中的处方。目标1将评估临床实践指南变化的影响通过使用全国代表性的数据库目标2和3将检查可能影响他汀类药物处方的更细粒度的提供者水平因素 (i.e.,肾脏护理对心血管风险管理的贡献，初级保健提供者（PCP）了解预防性心血管护理指南，PCP对CKD患者心血管风险的认知患者），并将其与个人实践行为相关联，使用来自旧金山弗朗西斯科健康中心的数据。网络，一个地方公共卫生系统，不成比例地照顾社会经济地位低的个人。研究设计将涉及对大型国家数据集（国家卫生和健康数据集）的横截面分析。营养检查调查; NHANES）的Aim 1和来自一个人的电子健康记录的本地数据集保健提供系统（旧金山弗朗西斯科保健网），目标2和3。目标3还将包括调查当地初级保健提供者评估对指南的认识和对心血管风险的看法 CKD患者。

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

CKD Progression From the Time of Estimated GFR-Based Waitlist Eligibility and Racial Disparities in Transplant Access.

DOI：
10.1053/j.ajkd.2021.08.010
发表时间：
2022-06
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
0
作者：
通讯作者：

Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use Among Hypertensive US Adults With Albuminuria.

DOI：
10.1161/hypertensionaha.120.16281
发表时间：
2021-01
期刊：
Hypertension (Dallas, Tex. : 1979)
影响因子：
0
作者：
Chu CD;Powe NR;McCulloch CE;Banerjee T;Crews DC;Saran R;Bragg-Gresham J;Morgenstern H;Pavkov ME;Saydah SH;Tuot DS;Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
通讯作者：
Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team

Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity.

DOI：
10.1186/s12875-022-01910-9
发表时间：
2022-11-24
期刊：
BMC primary care
影响因子：
0
作者：
Chu CD;Powe NR;Shlipak MG;Scherzer R;Tummalapalli SL;Estrella MM;Tuot DS
通讯作者：
Tuot DS

Trends in Chronic Kidney Disease Care in the US by Race and Ethnicity, 2012-2019.

DOI：
10.1001/jamanetworkopen.2021.27014
发表时间：
2021-09-01
期刊：
JAMA network open
影响因子：
13.8
作者：
Chu CD;Powe NR;McCulloch CE;Crews DC;Han Y;Bragg-Gresham JL;Saran R;Koyama A;Burrows NR;Tuot DS;Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
通讯作者：
Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team

Patient Awareness of CKD: A Systematic Review and Meta-analysis of Patient-Oriented Questions and Study Setting.