权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

基本信息

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
项目类别：
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

项目摘要

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.

摘要