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.

抽象的糖尿病性肾脏疾病（DKD）是一个巨大而越来越多的公共卫生问题，与高显着的心血管发病率/死亡率和肾衰竭，除了构成重要的经济美国卫生系统的负担。 DKD患者在提供指南时存在显着差距 - 建议降低心血管疾病和肾衰竭风险的治疗方法。以前研究旨在解决这些差距的干预措施依赖于负担沉重的初级保健团队，并且仅显示适度的成功。拟议研究的总体目标是设计和试行主动肾脏病电子咨询，利用电子健康记录鉴定DKD患者谁可能会从肾脏科专业知识中受益，但其肾脏疾病不足以需要人肾脏科转介。作为这项干预的一部分，肾脏科医生将执行目标，自动化通过审查患者图表并提供个性化的咨询（炸玉米饼）建议侧重于提供指南指示的DKD护理。对于有限的卫生系统炸玉米饼的非专业人士能力提供了一种“高触摸”方法来扩展子专业与初级保健合作的专业知识，以达到广泛的人口。对于DKD，炸玉米饼具有潜力促进既定的DKD疗法的利用和摄取新型疗法，例如钠葡萄糖共转运蛋白2抑制剂。该项目的具体目的是1）进行半结构化访谈初级保健临床医生和肾病学家了解炸玉米饼干预的最有用的要素； 2）使用微仿真方法来确定针对炸玉米饼的最佳策略以优化基于本地环境中现有实践模式的影响和平等； 3）评估可行性和炸玉米饼在一个公共卫生保健提供系统中实施试点的可接受性。实现目标并为Chu博士做准备独立研究职业作为实施科学家致力于改善慢性肾脏病护理，他将被一个专家团队召集定性研究方法，肾脏疾病流行病学，模拟建模和实施科学。具体而言，该建议将使Chu博士实现以下培训目标：1）实施正式实施科学方面的教学和修改培训； 2）开发设计和进行定性的技能研究为干预设计提供的研究； 3）学会应用模拟建模方法来预测干预的潜在影响； 4）获得进行实施和实施试点研究的经验评估护理提供干预措施。这些目标的完成将生成初步数据并提供培训基金会，以支持R级建议，以研究炸玉米饼或其他人群的有效性改善潜水卫生系统中DKD护理的健康方法。