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Electronic Tools to Increase Recognition and Improve Primary Care Management for Hypertension in Chronic Kidney Disease

电子工具可提高对慢性肾病高血压的认识并改善初级保健管理

基本信息

批准号：
10689403
负责人：
Lipika Samal
金额：
$ 25.05万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10689403
关键词：
Address Adopted Albumins Behavioral Blood Blood Pressure Cardiovascular Diseases Caring Chronic Chronic Kidney Failure Clinic Clinical Clinical Trials Computers Country Creatinine Cross-Over Studies Data Diagnosis Dialysis procedure Disease Management Disease Progression Effectiveness of Interventions Electronic Health Record End stage renal failure Grant Health Heart Human Hypertension Intention Intervention Kidney Diseases Kidney Failure Laboratories Length Measures Methods Outcome Patient Care Patients Persons Pharmaceutical Preparations Physicians Population Primary Care Physician Primary Health Care Process Measure Quality of life Questionnaires Randomized Randomized Controlled Trials Recommendation Registries Research Project Grants Risk Factors Running Serum Testing Urine Validation Work base behavior change behavioral economics blood pressure control cardiovascular risk factor clinical decision support computerized tools disease diagnosis effectiveness evaluation effectiveness testing evidence base hypertension control hypertension treatment improved innovation intervention effect mortality prevent primary care setting provider behavior secondary outcome symposium tool

项目摘要

The greatest opportunity to improve the length and quality of life for patients with chronic kidney disease (CKD) is to identify and intervene early on the chronic conditions that contribute to CKD progression and poor outcomes. Although both CKD and hypertension (HTN), the main risk factor for CKD progression, are not difficult to diagnose, both often go unrecognized by PCPs. Since patients with CKD generally receive their care from primary care physicians (PCPs), primary care-based interventions have the greatest potential to improve health for CKD patients. Electronic health records (EHRs) present an innovative delivery approach to improve CKD management in primary care. However, the impact of EHRs, registries and clinical decision support (CDS) has been modest in CKD. Hypothesis: The mean systolic blood pressure of the CKD population can be decreased by an intervention with three innovative features: 1) methods to synthesize EHR data in order to identify under-diagnosed chronic conditions, 2) iterative improvement in CDS content through human factors methods to maximize the “informativeness” of the CDS, and 3) the use of behavioral economic principles to create behavioral “nudges” internal and external to the CDS. Specific Aim 1: To develop and validate the intervention. Specific Aim 1a: To develop and validate the CDS that will: 1) synthesize existing laboratory tests, medication orders, and vital sign data; 2) increase recognition of CKD, 3) increase recognition of uncontrolled HTN in CKD patients; and 4) deliver evidence-based CKD and HTN management recommendations. The validation will consist of an 8-week silent run-in period and chart review. Specific Aim 1b: To improve the “informativeness” of the content of the CDS using human factors methods, specifically by conducting a “think-aloud” study. Specific Aim 1c: To develop a “wrap-around” intervention including three behavioral “nudges”: 1) pre-checked default orders, 2) an in-person conference with PCPs to obtain their commitment to follow the CDS recommendations, and 3) a required “accountable justification” if the PCP does not follow the CDS recommendations. Specific Aim 2: To test the effectiveness of the intervention. Specific Aim 2a: To evaluate whether the intervention developed in Aim 1 significantly decreases mean systolic blood pressure in a population of CKD patients with blood pressure > 140/90, N=2,350 (N derived from EHR data about primary care patients at 15 clinics). We will evaluate the effectiveness of the intervention in a pragmatic, cluster-randomized controlled trial, randomized at the level of the physician (180 PCPs). Secondary outcomes will include hypertension-specific process measures, such as treatment intensification. Specific Aim 2b: To evaluate whether the intervention improves process measures for quality of CKD care including: documented CKD diagnosis, annual serum creatinine test, and annual urine albumin test. Specific Aim 2c: To perform a cross-over study in order to evaluate the effect of the intervention on PCP behavior and PCPs' intention to change behavior, as measured by a validated 12-item questionnaire.

延长慢性肾病 (CKD) 患者的生活长度和提高生活质量的最佳机会是尽早发现并干预导致 CKD 进展和不良的慢性病结果。尽管 CKD 和高血压 (HTN)（CKD 进展的主要危险因素）并不两者都难以诊断，而且常常不被 PCP 识别。由于 CKD 患者通常会接受护理根据初级保健医生 (PCP) 的说法，基于初级保健的干预措施最有可能改善 CKD 患者的健康。电子健康记录 (EHR) 提供了一种创新的交付方法来改善初级保健中的 CKD 管理。然而，电子病历、登记和临床决策支持的影响 (CDS) 在 CKD 中的作用不大。假设：CKD 人群的平均收缩压可以为通过具有三个创新特征的干预措施来减少：1）合成 EHR 数据的方法，以便识别未确诊的慢性病，2) 通过人为因素迭代改进 CDS 内容最大化 CDS“信息性”的方法，以及 3）使用行为经济学原理在 CDS 内部和外部创建行为“推动”。具体目标 1：开发并验证干涉。具体目标 1a：开发和验证 CDS，它将：1) 综合现有实验室测试、用药单和生命体征数据； 2) 增加对 CKD 的认可，3) 增加对 CKD 患者未控制的高血压； 4) 提供基于证据的 CKD 和 HTN 管理建议。验证将包括 8 周的静默磨合期和图表审查。具体目标 1b：使用人为因素方法提高 CDS 内容的“信息性”，特别是通过进行“出声思考”研究。具体目标 1c：制定“环绕式”干预措施，包括三项行为“推动”：1) 预先检查默认订单，2) 与 PCP 进行面对面会议，以获得他们的意见承诺遵循 CDS 建议，以及 3) 如果 PCP 这样做，则需要提供“负责任的理由” 不遵循 CDS 建议。具体目标 2：测试干预措施的有效性。具体的目标 2a：评估目标 1 中制定的干预措施是否显着降低平均收缩压血压 > 140/90 的 CKD 患者群体中的血压，N=2,350（N 来自 EHR 数据关于 15 个诊所的初级保健患者）。我们将以务实的方式评估干预措施的有效性，整群随机对照试验，在医生层面进行随机化（180 位 PCP）。次要结果将包括针对高血压的具体过程措施，例如强化治疗。具体目标 2b：评估干预措施是否改善了 CKD 护理质量的流程措施，包括： CKD 诊断、每年血清肌酐检测、每年尿白蛋白检测。具体目标 2c：执行交叉研究，以评估干预措施对 PCP 行为和 PCP 意图的影响改变行为，通过经过验证的 12 项调查问卷进行衡量。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial.

DOI：
10.1136/bmjopen-2021-054065
发表时间：
2021-12-22
期刊：
BMJ open
影响因子：
2.9
作者：
Kilgallon JL;Gannon M;Burns Z;McMahon G;Dykes P;Linder J;Bates DW;Waikar S;Lipsitz S;Baer HJ;Samal L
通讯作者：
Samal L

Unpacking Contributors to CKD Incidence and Progression: Time to Move Beyond Traditional Risk Factors.

揭开 CKD 发病率和进展的影响因素：是时候超越传统风险因素了。

DOI：
10.1053/j.ajkd.2023.02.002
发表时间：
2023
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
0
作者：
Hansrivijit,Panupong;Samal,Lipika;Mendu,MallikaL
通讯作者：
Mendu,MallikaL

Human-centered design of clinical decision support for management of hypertension with chronic kidney disease.

DOI：
10.1186/s12911-022-01962-y
发表时间：
2022-08-13
期刊：
BMC MEDICAL INFORMATICS AND DECISION MAKING
影响因子：
3.5
作者：
Garabedian, Pamela M.;Gannon, Michael P.;Aaron, Skye;Wu, Edward;Burns, Zoe;Samal, Lipika
通讯作者：
Samal, Lipika

Health information technology to improve care for people with multiple chronic conditions.