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.

摘要 糖尿病肾病（DKD）是一个巨大的和日益增长的公共卫生问题，与糖尿病肾病相关。 显著的心血管发病率/死亡率和肾衰竭，除了造成显著的经济损失外， 这是美国卫生系统的负担。DKD患者在提供指南方面存在显著差距- 推荐的治疗方法，以降低心血管疾病和肾衰竭的风险。先前研究 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， 只取得了适度的成功。拟议研究的总体目标是设计和试点干预措施， 主动式肾脏病学电子咨询，利用电子健康记录识别DKD患者 谁可能受益于肾脏病学专业知识，但其肾脏疾病不严重，需要在- 个人肾病转诊。作为这种干预的一部分，肾科医生将进行有针对性的，自动化的 通过审查患者病历并提供个性化的咨询（TACos）， 建议集中于提供指南指示的DKD护理。对于卫生系统， 专科医生亲自就诊的能力，TACos提供了一种“高接触”的方法来扩展专科医生 专业知识与初级保健合作，以覆盖更广泛的人群。对于DKD，TACos有可能 促进既有的DKD疗法的利用，也促进新疗法的吸收，如钠- 葡萄糖协同转运蛋白2抑制剂。本项目的具体目标是：1）进行半结构化访谈 初级保健临床医生和肾病学家了解TACo干预的最有帮助的要素; 2） 使用微观模拟建模方法来确定针对TACos的最佳策略， 根据当地现有的实践模式，评估影响和公平性;以及3）评估可行性， 在一个公共卫生保健提供系统中试点实施TACos的可接受性。 为了实现目标，并准备朱博士的独立研究生涯作为一个实施 一位专注于改善慢性肾病护理的科学家，他将接受一个专家团队的指导， 定性研究方法，肾脏疾病流行病学，模拟建模和实施科学。 具体而言，本建议将使朱博士实现以下培训目标：1）进行正式的 实施科学的教学和指导培训; 2）发展设计和进行定性分析的技能 研究为干预设计提供信息; 3）学习应用模拟建模方法来预测 干预措施的潜在影响;以及4）获得开展试点研究的经验， 评估护理提供干预。这些目标的完成将产生初步数据，并提供 一个培训基金会，用于支持研究TACos或其他人群有效性的R级提案 在不同的卫生系统中采取卫生方法改善DKD护理。