Health Information Technology for Chronic Kidney Disease Management

慢性肾脏病管理的健康信息技术

• 批准号: 8911826
• 负责人: Lipika Samal
• 金额: $ 18.28万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8911826
• 关键词: Albumins; American; Award; Bicarbonates; Biometry; Boston; Calcium; Caring; Chronic; Chronic Kidney Failure; Clinic; Clinical; Clinical Trials; Cluster randomized trial; Computers; Consensus; Creatinine; Data; Data Collection; Development Plans; Diagnosis; Dialysis procedure; Disease; Disease Management; Early Diagnosis; Early treatment; End stage renal failure; Enrollment; Ensure; Environment; Epidemiologist; Epidemiology; FarGo; Funding; Goals; Growth; Health; Health Care Costs; Healthcare Systems; Heart; Hemodialysis; Hospitals; Human; Informatics; Information Systems; Inherited; Institutes; Internal Medicine; Internist; Intervention; K-Series Research Career Programs; Kidney; Kidney Diseases; Laboratories; Light; Literature; Manuals; Massachusetts; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; Monitor; Nephrology; Outcome; Patients; Physicians; Primary Care Physician; Primary Health Care; Public Health; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Resource Informatics; Risk; Serum; Serum Albumin; Societies; Staging; Structure; Systemic disease; Testing; Time; Training; Translational Research; Urine; Woman; Work; career; career development; cohort; computerized tools; cooking; cost; design; disease diagnosis; electronic data; health information technology; high risk; improved; innovation; inorganic phosphate; novel; point of care; predictive modeling; prevent; primary care setting; primary outcome; response; routine care; satisfaction; secondary outcome; success; tool; usability; user-friendly

DESCRIPTION (provided by applicant): This is an application for a K23 Career Development Award for Dr. Lipika Samal, a general internist at Brigham and Women's Hospital (BWH) in Boston, Massachusetts. Dr. Samal is establishing herself as an investigator in health information technology (HIT) to improve outcomes in patients with chronic kidney disease (CKD). Her career goal is to become an independently funded clinician investigator. This K23 award will help her to accomplish the following goals: 1) to obtain advanced training in biostatistics, epidemiology, and HIT research methodology, 2) to improve clinical expertise in management of CKD, 3) to develop and implement an HIT intervention in primary care clinics to improve monitoring, treatment, and referral for patients with CKD, and 4) to develop as an investigator to ensure transition to independent funding status. To achieve these goals, Dr. Samal has chosen a mentoring team committed to her success as a clinician investigator. Her primary mentor is Dr. David Bates, Chief of General Internal Medicine at BWH and an internationally renowned HIT researcher. Her secondary mentors are Dr. Sushrut Waikar, a nephrologist and clinical researcher, and Dr. Jeffrey Linder, a primary care physician and HIT researcher. She will also receive guidance from Dr. Joseph Bonventre, Chief of the Renal Division at BWH and past President of the American Society of Nephrology, as well as Dr. Thomas Sequist, a primary care physician and CKD researcher, biostatistician Dr. John Orav, and epidemiologist Dr. Francis Cook. A large proportion of patients with CKD receive care in primary care clinics, so interventions in the primary care setting are important for delaying progression to end stage renal disease (ESRD). HIT systems can prompt early diagnosis of CKD and can help physicians to stratify patients according to risk of progression to ESRD. Despite this, relatively few studies have been done leveraging HIT in CKD management as compared to other chronic conditions. We propose to develop and evaluate an innovative HIT tool for CKD management in primary care clinics. Our specific aims are as follows. Specific Aim 1: Develop an HIT application to calculate risk of progression to ESRD according to a risk prediction model developed by Tangri, et. al.; Specific Aim 1a: Develop a search method to find existing urine albumin to creatinine ratio, serum calcium, serum phosphate, serum albumin, and serum bicarbonate values. Validate the search method through manual chart review; Specific Aim 1b: Prepare for implementation of the HIT application by i) designing a user interface after gathering PCP input, ii) conducting usability testing, and iii) convening an interdisciplinary pane to determine a risk threshold for referral within our healthcare system; Specific Aim 2: Conduct a cluster randomized trial to determine the effect of the HIT application on the primary outcome: the completion of the necessary tests for the risk prediction model (urine albumin to creatinine ratio, serum calcium, serum phosphate, serum albumin, and serum bicarbonate) for CKD patients in primary care. Secondary outcomes will include nephrology referrals; doubling of serum creatinine; initiation of hemodialysis; and PCP satisfaction. The clinical trial enrollment and data collection will rely on electronic data collected during routine care, a low-cost, feasibl approach to research. The candidate's epidemiology and informatics background, mentorship, and strong environment of informatics resources make these specific aims attainable during the award period. Most patients with CKD are cared for in primary care settings. Early stage management is suboptimal, and this represents a significant public health problem. The most important end result of this study is a proof of concept that a risk prediction model with laboratory results "built-in" can promote appropriate nephrology referral. The human-centered research in Aim 1 will contribute to a user-friendly HIT tool for this project and will contribute o the literature on primary care HIT interventions. The results from Aim 2 will contribute to preliminary data for an R01 with nephrology referral as the primary outcome. The research performed during the K23 period will inform a subsequent R01 focused on improving additional aspects of CKD management in ambulatory clinics, which is a form of translational research. This information may be useful in future research on improving CKD care in general, and is applicable to other renal diseases including other systemic diseases, inherited diseases, or any form of CKD where monitoring and treatment initially occurs in the primary care setting.

描述（由申请人提供）：这是一份K23职业发展奖的申请，申请人是马萨诸塞州波士顿布里格姆妇女医院（BWH）的普通内科医生Lipika Samal博士。Samal博士将自己定位为健康信息技术（HIT）的研究者，以改善慢性肾脏病（CKD）患者的预后。她的职业目标是成为一名独立资助的临床研究者。K23奖将帮助她实现以下目标：1）获得生物统计学、流行病学和HIT研究方法的高级培训，2）提高CKD管理的临床专业知识，3）在初级保健诊所开发和实施HIT干预措施，以改善CKD患者的监测、治疗和转诊，和4）发展成为一名调查员，以确保过渡到独立的资助地位。为了实现这些目标，Samal博士选择了一个指导团队，致力于她作为临床研究者的成功。她的主要导师是大卫贝茨博士，在BWH和国际知名的HIT研究人员普通内科主任。她的二级导师是肾脏病学家和临床研究员Sushrut Waikar博士和初级保健医生和HIT研究员Jeffrey Linder博士。她还将接受BWH肾脏科主任、美国肾脏病学会前任主席Joseph Bonventre博士、初级保健医生和CKD研究人员托马斯塞奎斯特博士、生物统计学家John Orav博士和流行病学家弗朗西斯库克博士的指导。 很大一部分CKD患者在初级保健诊所接受治疗，因此初级保健环境中的干预措施对于延迟进展为终末期肾病（ESRD）非常重要。HIT系统可以促进CKD的早期诊断，并可以帮助医生根据进展为ESRD的风险对患者进行分层。尽管如此，与其他慢性疾病相比，在CKD管理中利用HIT的研究相对较少。我们建议开发和评估一种创新的HIT工具，用于初级保健诊所的CKD管理。我们的具体目标如下。具体目标1：开发HIT应用程序，根据Tangri等人开发的风险预测模型计算进展为ESRD的风险。等;具体目标1a：开发一种检索方法，以查找现有的尿白蛋白/肌酐比值、血清钙、血清磷酸盐、血清白蛋白和血清碳酸氢盐值。通过手动图表审查确定检索方法;具体目标1b：通过以下方式为HIT应用程序的实施做好准备：i）在收集PCP输入后设计用户界面，ii）进行可用性测试，iii）召集跨学科小组，以确定我们的医疗保健系统内转诊的风险阈值;具体目标2：进行一项随机分组试验，以确定HIT应用对主要结局的影响：完成风险预测模型的必要测试（尿白蛋白与肌酸酐比率、血清钙、血清磷酸盐、血清白蛋白和血清碳酸氢盐）。次要结局将包括肾病转诊;血清肌酐加倍;开始血液透析;和PCP满意度。 临床试验招募和数据收集将依赖于常规护理期间收集的电子数据，这是一种低成本，可行的研究方法。候选人的流行病学和信息学背景，指导和强大的信息学资源环境使这些具体目标在获奖期间可以实现。 大多数CKD患者在初级保健机构接受护理。早期管理不理想，这是一个重大的公共卫生问题。这项研究最重要的最终结果是一个概念的证明，一个风险预测模型与实验室结果“内置”可以促进适当的肾脏病转诊。目标1中以人为本的研究将有助于为该项目提供一个用户友好的HIT工具，并将有助于初级保健HIT干预的文献。目标2的结果将为R 01的初步数据提供贡献，其中肾脏科转诊作为主要结局。 在K23期间进行的研究将为随后的R 01提供信息，该R 01侧重于改善门诊CKD管理的其他方面，这是一种转化研究形式。这些信息可能有助于未来改善CKD护理的研究，并适用于其他肾脏疾病，包括其他全身性疾病，遗传性疾病或任何形式的CKD，其中监测和治疗最初发生在初级保健环境中。