Targeted Automated Nephrology e-Consultation for Diabetic Kidney Disease

糖尿病肾病有针对性的自动化肾病电子咨询

• 批准号: 10591976
• 负责人: Chi Chu
• 金额: $ 19.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-23 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591976
• 关键词: Address; Affect; Attention; Cardiovascular Diseases; Cardiovascular system; Caring; Chronic Kidney Failure; Collaborations; Consultations; Data; Diabetic Nephropathy; Dimensions; Disease Management; Disease Progression; Disparity; Economic Burden; Education; Effectiveness; Electronic Health Record; Electronics; Elements; Eligibility Determination; End stage renal failure; Epidemiology; Equity; Ethnic Population; Failure; Foundations; Glucose; Goals; Guidelines; Health; Health system; Healthcare; Healthcare Systems; Integrated Health Care Systems; Intervention; Intervention Studies; Interview; Kidney; Kidney Diseases; Kidney Failure; Learning; Mentors; Modeling; Morbidity - disease rate; Nephrology; Patient Selection; Patients; Pattern; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Prevention; Primary Care; Provider; Public Health; Qualitative Methods; Qualitative Research; Random Allocation; Recommendation; Records; Research; Research Methodology; Resources; Risk Factors; Risk Reduction; San Francisco; Scientist; Self Management; Shoulder; Sodium; Specialist; Structure; Surveys; System; Touch sensation; Training; Variant; Veterans Health Administration; Visit; acceptability and feasibility; burden of illness; cardiovascular disorder risk; cardiovascular risk factor; care delivery; care outcomes; career; clinical decision support; design; disease registry; disparity reduction; effectiveness evaluation; effectiveness study; ethnic disparity; ethnic minority; experience; health care delivery; health care disparity; health disparity; health equity; implementation science; implementation study; improved; inhibitor; insight; intervention delivery; medical specialties; models and simulation; mortality; novel therapeutics; patient outreach; population health; post implementation; pressure; prevent; primary care clinician; primary care patient; primary care provider; primary care team; racial disparity; racial minority; racial population; research study; response; skills; success; symporter; therapy design; treatment as usual; treatment pattern; uptake; urban public health

ABSTRACT Diabetic kidney disease (DKD) is an enormous and growing public health problem that is associated with significant cardiovascular morbidity/mortality and kidney failure, in addition to posing a significant economic burden for the US health system. Patients with DKD experience significant gaps in the delivery of guideline- recommended treatments for reducing the risk of cardiovascular disease and kidney failure. Previously studied interventions intended to address these gaps have relied on overburdened primary care teams and have shown only modest success. The overall goal of the proposed research is to design and pilot an intervention of proactive nephrology e-consultation which leverages the electronic health record to identify patients with DKD who might benefit from nephrology expertise, but whose kidney disease is not severe enough to require in- person nephrology referral. As part of this intervention, nephrologists would perform targeted, automated consultations (TACos) for eligible patients by reviewing patient charts and providing individualized recommendations focused on delivering guideline-indicated DKD care. For health systems with limited subspecialist capacity for in-person visits, TACos offer a “high-touch” approach to extending subspecialty expertise in collaboration with primary care to reach a broader population. For DKD, TACos have the potential to promote both utilization of established DKD therapies and uptake of novel therapies, such as sodium- glucose cotransporter 2 inhibitors. The specific aims of this project are 1) to conduct semi-structured interviews of primary care clinicians and nephrologists to understand the most helpful elements of a TACo intervention; 2) to use a microsimulation modeling approach to determine the best strategies for targeting TACos for optimizing impact and equity based on existing practice patterns in a local setting; and 3) to evaluate the feasibility and acceptability of a pilot implementation of TACos in one public health care delivery system. To accomplish the goals and to prepare Dr. Chu for an independent research career as an implementation scientist focused on improving chronic kidney disease care, he will be mentored by a team of experts in qualitative research methods, kidney disease epidemiology, simulation modeling, and implementation science. Specifically, this proposal will allow the Dr. Chu to achieve the following training goals: 1) undertake formal didactic and mentored training in implementation science; 2) develop skills to design and conduct qualitative research studies to inform intervention design; 3) learn to apply simulation modeling approaches to predict potential impact of interventions; and 4) gain experience conducting a pilot study that implements and evaluates a care delivery intervention. Completion of these aims will generate the preliminary data and provide a training foundation to support an R-level proposal to study the effectiveness of TACos or other population health approaches to improve DKD care in diverse health systems.

抽象的 糖尿病肾病 (DKD) 是一个巨大且日益严重的公共卫生问题，与以下疾病相关： 显着的心血管发病率/死亡率和肾衰竭，除了造成显着的经济影响 美国医疗系统的负担。 DKD 患者在提供指南方面存在显着差距—— 降低心血管疾病和肾衰竭风险的推荐治疗方法。以前学过 旨在解决这些差距的干预措施依赖于负担过重的初级保健团队，并且 仅取得了一定的成功。拟议研究的总体目标是设计和试点干预措施 主动肾病电子咨询，利用电子健康记录来识别 DKD 患者 谁可能受益于肾脏病学专业知识，但其肾脏疾病还没有严重到需要接受治疗 人肾科转诊。作为干预的一部分，肾病专家将进行有针对性的、自动化的治疗 通过审查患者图表并提供个性化咨询，为符合条件的患者提供咨询 (TACos) 建议侧重于提供指南指示的 DKD 护理。对于资源有限的卫生系统 专科人员亲自就诊的能力，TACO 提供“高接触”方法来扩展专科范围 与初级保健合作的专业知识，以覆盖更广泛的人群。对于 DKD，TACos 有潜力 促进现有 DKD 疗法的利用和新型疗法的采用，例如钠- 葡萄糖协同转运蛋白2抑制剂。该项目的具体目标是1）进行半结构化访谈 初级保健临床医生和肾病专家了解 TACo 干预中最有用的要素； 2） 使用微观模拟建模方法来确定针对 TAC 进行优化的最佳策略 基于当地现有实践模式的影响力和公平性； 3) 评估可行性 在一个公共医疗保健提供系统中试点实施 TACos 的可接受性。 实现目标并为朱博士的独立研究生涯做好准备作为实施 科学家专注于改善慢性肾病护理，他将得到一组专家的指导 定性研究方法、肾脏疾病流行病学、模拟建模和实施科学。 具体来说，该提案将使朱博士实现以下培训目标：1）进行正式的培训 实施科学方面的教学和指导培训； 2）培养设计和进行定性的技能 研究为干预设计提供信息； 3）学习应用仿真建模方法进行预测 干预措施的潜在影响； 4) 获得进行试点研究的经验，该研究实施和 评估护理服务干预。完成这些目标将生成初步数据并提供 支持 R 级提案的培训基金会，以研究 TAC 或其他人群的有效性 改善不同卫生系统 DKD 护理的健康方法。