Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

描述（由申请人提供）：由于肾病学家相对缺乏，初级保健提供者（PCP）为慢性肾病（CKD）患者提供大部分护理。然而，PCP不承认CKD的存在以及肾病学家，也不知道现有的肾脏疾病指南。这些因素导致CKD患者结局不佳。然而，很少有研究探讨了改善CKD患者PCP护理的方法。计算机化的临床决策支持系统（CDSS）是一种有效的工具，以加强PCP提供护理在其他环境中，但其在CKD护理的作用尚未确定。 该申请的长期目标是：1）描述当前PCP在CKD患者护理中的实践模式; 2）通过使用CDSS提高PCP对CKD的认识并优化PCP对循证CKD指南的依从性，从而改善CKD结局。具体目标是1）。确定在建立常规eGFR报告之前和之后，PCP识别CKD 3b-5（eGFR<45 ml/min/1.73 m2）的程度。2）。确定（a）在过去一年中有尿斑点白蛋白/肌酐比值（ACR），（B）在常规eGFR报告之前和之后接受血管紧张素转换酶抑制剂（ACE）或血管紧张素受体阻滞剂（AR B）的CKD 3 B-5患者比例。3）。证明一项PCP教育和临床提醒的随机对照试验与仅提供者教育相比，在增加转诊至肾病科医生的CKD 3b-5患者比例方面的效果。 该提案包括在单个学术临床研究中心的CKD 3b-5门诊患者中进行的两阶段临床研究。在第一阶段，将从电子病历（EMR）中提取数据，以确定在常规eGFR报告机构之前和之后诊断代码为CKD、ACR和ACE/ARB治疗的CKD 3b-5患者的比例。在第二阶段，一项为期6个月的PCP教育和EMR临床提醒与单独教育的试点随机对照试验将比较CKD 3b-5患者使用肾脏病学药物、ACR和ACE/ARB的比例。干预包括教育和自动EMR提醒，以参考肾脏病学和测量CKD 3b-5的ACR。 肾脏疾病是一种越来越常见的疾病，但由于肾脏医生的稀缺，初级保健医生在没有专家帮助的情况下治疗许多肾脏疾病患者。研究表明，向这些患者提供的护理往往是次优的。该提案将调查当患者患有严重肾脏疾病时自动提醒医生并建议应采取的干预措施的计算机化警报是否会改善对慢性肾脏疾病患者的护理。

DESCRIPTION (provided by applicant): Due to the relative paucity of nephrologists, primary care providers (PCPs) deliver most of the care to patients with chronic kidney disease (CKD). However, PCPs do not recognize the presence of CKD as well as nephrologists nor are they aware of existing kidney disease guidelines. These factors contribute to inadequate outcomes in CKD patients. Yet, very few studies have examined methods to improve PCP care of CKD patients. Computerized clinical decision support systems (CDSS) are an effective tool for enhancing PCP provision of care in other settings, but their role in CKD care has not been established. The long-term objectives of the application are: 1)To characterize current PCP practice patterns in the care of CKD patients and 2)To improve CKD outcomes by increasing PCP recognition of CKD and optimizing PCP compliance with evidence-based CKD guidelines through the use of CDSS. The specific aims are 1). To determine the extent that PCPs recognize CKD 3b-5 (eGFR<45ml/min/1.73m2) before and after the institution of routine eGFR reporting. 2). To ascertain the proportion of patients with CKD 3b-5 who (a) had a urinary spot albumin to creatinine ratio (ACR) in the past year, (b) are on an angiotensin converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARB) prior to and following routine eGFR reporting. 3). To demonstrate the effect of a randomized controlled trial of PCP education and clinical reminders compared to provider education alone to increase the proportion of patients with CKD 3b-5 referred to a nephrologist. The proposal consists of a two-phase clinical study among outpatients with CKD 3b-5 at a single academic clinical site. In the first phase, data will be abstracted from electronic medical records (EMR) to determine the proportion of CKD 3b-5 patients with a diagnosis code for CKD, ACR, and ACE/ARB treatment before and after the institution of routine eGFR reporting. In the second phase, a 6 month pilot randomized controlled trial of PCP education and EMR clinical reminders versus education alone will compare the proportion of CKD 3b-5 patients with a nephrology referal, ACR, and ACE/ARB use. The intervention consists of education and automated EMR reminders to refer to nephrology and measure ACR in CKD 3b-5. Kidney disease is an increasingly common disorder but due to the scarcity of kidney doctors, primary care physicians treat many kidney disease patients without the help of a specialist. Studies have shown that the care delivered to these patients is often suboptimal. This proposal will investigate whether computerized alerts that automatically remind doctors when their patients have significant kidney disease and suggest interventions that should be ordered will improve the care delivered to patients with chronic kidney disease.