A Technology-Driven Intervention to Improve Identification and Management of Chronic Kidney Disease in Primary Care

技术驱动的干预措施可改善初级保健中慢性肾脏病的识别和管理

• 批准号: 10004030
• 负责人: JOANN M SPERL-HILLEN
• 金额: $ 48.58万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10004030
• 关键词: Adult; Albumins; Albuminuria; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Area; Awareness; Blood Glucose; Cardiovascular system; Caring; Chronic Disease; Chronic Kidney Failure; Clinic; Clinic Visits; Clinical; Clinical Decision Support Systems; Collaborations; Consultations; Creatinine; Diabetes Mellitus; Diagnosis; Diagnostic; Disease Progression; Electrolytes; Electronic Health Record; Elements; Emergency department visit; End stage renal failure; Event; Evidence based treatment; Feedback; Glomerular Filtration Rate; Guidelines; Health Benefit; Hospitalization; Hypertension; Hypoglycemia; Hypotension; Intervention; Investments; Kidney; Laboratories; Leadership; Medical; Methods; Monitor; Nephrology; Online Systems; Outpatients; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Primary Care Physician; Primary Health Care; Private Sector; Privatization; Process; Provider; Public Health Informatics; Public Sector; Quality of Care; Quality of life; Randomized; Recommendation; Reporting; Research Contracts; Safety; Specialist; System; Technology; Testing; Time; Training; Translating; United States National Institutes of Health; Visit; base; blood glucose regulation; blood pressure regulation; cardiovascular risk factor; care coordination; care outcomes; care providers; care systems; clinical decision support; clinical practice; cost; effective intervention; evidence base; glycemic control; hypertension control; implementation strategy; improved; indexing; literacy; mortality; point of care; prevent; primary care setting; prototype; racial disparity; rural area; safety net; secondary analysis; shared decision making; tool; treatment as usual; urban area

Project Summary Chronic kidney disease (CKD) is a common and serious chronic disease that often leads to end-stage renal disease and major cardiovascular events. Although evidence-based CKD care can slow disease progression and avert complications, less than 10% of CKD patients currently receive major elements of CKD care in a timely fashion. The objective of this project is to develop, implement, and evaluate a technology-driven and team-based intervention to improve quality of care and clinical outcomes for patients with stage 3-4 CKD. The proposed intervention uses a sophisticated Web-based clinical decision support (CDS) system that is seamlessly integrated within the electronic health record (EHR) to: (a) identify adults with CKD at primary care encounters; (b) suggest personalized evidence-based treatment options to increase the appropriate use of renoprotective antihypertensive medications, improve blood pressure control, and improve glycemic management in patients with diabetes; and (c) suggest to patients and providers when collaboration and consultation with nephrologists may be advisable. We rigorously test the impact of the intervention by randomly assigning 30 primary care clinics with approximately 120 primary care physicians and 6100 adults with evidence of stage 3-4 CKD to the CDS intervention versus usual care and assess intervention impact on 5 key evidence-based elements of care for patients with CKD: (i.) recognition and diagnosis of CKD in patients who meet diagnostic criteria; (ii.) adequate blood pressure control; (iii.) optimal angiotensin converting enzyme inhibitor or angiotensin receptor blocker use; (iv.) adequate glucose control; and (v.) nephrology consultation when appropriate. The intervention, referred to as CKD-CDS, provides patient-specific and stage-specific CKD treatment options in high- and low-literacy formats to the primary care provider (PCP) and patients at each primary care encounter to facilitate shared decision making. This CKD-CDS will be implemented using previously successful methods that in previous CDS studies have achieved very high use rates with patients (>75% of targeted patient encounters) for diabetes and high cardiovascular risk. Scalability of this NIH- developed, non-commercialized intervention strategy is supported by its current use (without the CKD identification or specific recommendations) in 4 large medical groups that provide care to 2,000,000 patients in rural and urban areas in 4 Midwestern states, with research contracts to extend use to more than 60 safety net clinics in an additional 14 states in 2018. If the addition of CKD-CDS to this tool is effective, the intervention is immediately scalable and could (a) improve quality of care for large numbers of CKD patients, thereby slowing progression of CKD and improving quality of life, (b) maximize the clinical return on massive public and private investments now being made in sophisticated outpatient EHR systems, and (c) provide a health informatics prototype that rapidly and consistently translates evolving evidence-based CKD clinical guidelines into delivery of personalized and coordinated CKD care within primary care settings.

项目概要 慢性肾脏病（CKD）是一种常见且严重的慢性疾病，常导致终末期肾病 疾病和主要心血管事件。尽管基于证据的 CKD 护理可以减缓疾病进展 并避免并发症，目前只有不到 10% 的 CKD 患者接受 CKD 护理的主要内容 及时时尚。该项目的目标是开发、实施和评估技术驱动和 基于团队的干预措施，以提高 3-4 期 CKD 患者的护理质量和临床结果。这 拟议的干预措施使用复杂的基于网络的临床决策支持（CDS）系统 无缝集成到电子健康记录 (EHR) 中，以：(a) 在初级保健中识别患有 CKD 的成年人 遭遇； (b) 建议个性化的循证治疗方案，以增加适当使用 肾脏保护性抗高血压药物，改善血压控制，改善血糖 糖尿病患者的管理； (c) 向患者和提供者提出合作和建议 建议咨询肾脏病专家。我们通过随机方式严格测试干预的影响 分配 30 个初级保健诊所，配备约 120 名初级保健医生和 6100 名成人 CKD 3-4 期 CDS 干预与常规护理的证据，并评估干预对 5 个关键的影响 CKD 患者护理的循证要素：(i.) 对以下患者进行 CKD 的识别和诊断： 符合诊断标准； (ii.) 充分控制血压； (iii.)最佳血管紧张素转化酶 抑制剂或血管紧张素受体阻滞剂的使用； (iv.) 充分的血糖控制； (v.) 肾脏科咨询 在适当的时候。该干预措施称为 CKD-CDS，提供针对特定患者和特定阶段的 CKD 向初级保健提供者 (PCP) 和患者提供高识字率和低识字率形式的治疗方案 初级保健会面以促进共同决策。该 CKD-CDS 将使用 在之前的 CDS 研究中，先前成功的方法已在患者中取得了非常高的使用率 （>75% 的目标患者遇到）糖尿病和高心血管风险。该 NIH 的可扩展性 已开发的非商业化干预策略得到其当前使用的支持（没有 CKD 识别或具体建议）在 4 个大型医疗集团中为 2,000,000 名患者提供护理 中西部 4 个州的农村和城市地区，签订了研究合同，将使用范围扩大到 60 多个安全网 2018 年在另外 14 个州开设了诊所。如果将 CKD-CDS 添加到该工具中是有效的，则干预措施是 立即可扩展，并且可以 (a) 提高大量 CKD 患者的护理质量，从而减缓 CKD 进展和改善生活质量，(b) 最大限度地提高大规模公共和私人的临床回报 目前正在对复杂的门诊 EHR 系统进行投资，并且 (c) 提供健康信息学 原型可快速、一致地将不断发展的基于证据的 CKD 临床指南转化为交付 初级保健机构内个性化和协调的 CKD 护理。