(MEnD-AKI) Multicenter Implementation of an Electronic Decision Support System for Drug-associated AKI

(MEnD-AKI) 药物相关 AKI 电子决策支持系统的多中心实施

• 批准号: 10414976
• 负责人: Azra Bihorac
• 金额: $ 63.05万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10414976
• 关键词: Accounting; Acute Renal Failure with Renal Papillary Necrosis; Address; Adopted; Adult; Adverse drug event; Caring; Cessation of life; Chronic; Clinical; Clinical Decision Support Systems; Clinical Practice Guideline; Computerized Medical Record; Cost Analysis; Coupled; Data; Decision Support Systems; Dependence; Development; Diagnostic; Dialysis procedure; Dose; Drug Modelings; Early Diagnosis; Effectiveness; Etiology; Event; Goals; Guidelines; Health system; Hospitalists; Hospitals; Incidence; Injury to Kidney; Intervention; Kidney Diseases; Laboratories; Length of Stay; Light; Machine Learning; Measures; Medical center; Operative Surgical Procedures; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Pharmaceutical Preparations; Pharmacists; Physicians; Predictive Analytics; Predictive Value; Provider; Publishing; Randomized; Randomized Controlled Trials; Recommendation; Recovery; Reporting; Research; Residual state; Risk; Risk Assessment; Sensitivity and Specificity; Series; Services; Site; Staging; Surveys; System; Testing; Therapeutic Intervention; Time; United States; Universities; Update; aging population; base; care providers; clinical decision support; clinical risk; comorbidity; cost; cost effectiveness; design; detection platform; effectiveness evaluation; equipment training; experience; group intervention; high risk; imaging agent; implementation cost; implementation intervention; improved; innovation; mortality; nephrotoxicity; non-drug; post intervention; premature; renal damage; risk prediction model; standard of care

Abstract Acute Kidney Injury (AKI) in the US has increased by 38% over the last eight years, with drugs as a major contributor to AKI in hospitalized patients. Drug-associated AKI (D-AKI) results in severe consequences with approximately 40% of patients experiencing in-hospital death or dialysis dependence and 70% having evidence of residual kidney damage following the initial D-AKI event. We have determined that many patients at high risk for AKI are identified late and often continue to receive nephrotoxic drugs until AKI becomes severe. Thus, we designed a proposal to address the need for early, appropriate management of nephrotoxins in high-risk patients by studying the effect of an advanced clinical decision support system (CDSS) for primary physicians and hospitalists aimed at reducing D-AKI in hospitalized adults. Specifically, we aim to 1) optimize the clinical performance of D-AKI risk-alerts generated by a clinical decision support system; 2) test whether an advanced clinical decision support system coupled with a pharmacist-led intervention improves short and long- term outcomes for patients with D-AKI; and 3) determine physician perception of the pharmacists’ performance, physician acceptance and cost-effectiveness of our intervention. In 2012 Kidney Disease Improving Global Outcomes (KDIGO) published the first comprehensive AKI clinical practice guideline. Recommendations include the use of standard criteria for defining and staging AKI and a series of stage-based management steps to be considered for all patients with AKI or at risk for developing it. However, clinicians have been slow to adopt these recommendations and some groups (most notably the US KDOQI expert panel), while endorsing the guideline overall, have called for more research testing the recommendations. Our proposal directly addresses this concern by testing whether a unique clinical decision support system identifying high risk patients coupled with an advanced pharmacist service directed to the primary physician can address D-AKI and drug dosing for other forms of AKI to improve patient care. Thus, our central goal is to examine the effect of a pharmacist-led intervention on the early detection and management of AKI, progression of and short-term recovery from AKI, and on various AKI-related outcomes.

抽象的 过去八年，美国的急性肾损伤 (AKI) 增加了 38%，其中药物是主要病因 导致住院患者 AKI 的因素。药物相关 AKI (D-AKI) 会导致严重后果 大约 40% 的患者经历院内死亡或透析依赖，70% 的患者患有 初始 D-AKI 事件后残留肾损伤的证据。我们已经确定很多患者 AKI 高危人群被发现较晚，并且经常继续接受肾毒性药物，直到 AKI 发生 严重。因此，我们设计了一项提案来满足对肾毒素进行早期、适当管理的需求 通过研究先进临床决策支持系统 (CDSS) 对高危患者的影响 医生和住院医师旨在减少住院成人的 D-AKI。具体来说，我们的目标是 1) 优化 临床决策支持系统生成的 D-AKI 风险警报的临床表现； 2）测试是否 先进的临床决策支持系统与药剂师主导的干预相结合，改善了短期和长期的 D-AKI 患者的长期结局； 3) 确定医生对药剂师的看法 我们的干预措施的表现、医生接受度和成本效益。 2012 年肾脏病改善全球成果 (KDIGO) 发表了第一份综合性 AKI 临床报告 练习指南。建议包括使用标准标准来定义和分期 AKI 以及 对所有 AKI 或有发生 AKI 风险的患者应考虑采取一系列基于阶段的管理步骤。 然而，临床医生在采纳这些建议方面进展缓慢，一些团体（尤其是美国 KDOQI 专家小组）在总体上认可该指南的同时，呼吁进行更多研究测试 建议。我们的建议通过测试是否有独特的临床决策来直接解决这个问题 识别高风险患者的支持系统加上针对患者的先进药剂师服务 主治医生可以解决 D-AKI 和其他形式 AKI 的药物剂量问题，以改善患者护理。因此，我们的 中心目标是检查药剂师主导的干预措施对早期发现和管理的影响 AKI、AKI 的进展和短期恢复，以及各种 AKI 相关结局。