A Risk Based Approach to Improving Management of Chronic Kidney Disease

描述(申请人提供)：慢性肾脏疾病影响2500多万美国人，与患者的发病率和死亡率以及高昂的医疗费用有关。初级保健是早期识别和处理慢性肾脏疾病的第一线。不幸的是，这种疾病仍然没有被初级保健医生和他们的医生认识到 患者；导致次优的护理质量和糟糕的健康结果。这项研究将评估电子警报，以对慢性肾脏疾病患者进行风险分层，并在电子健康记录中向初级保健医生提出有针对性的治疗建议。干预将在哈佛先锋医疗协会进行，这是一个由马萨诸塞州东部14个健康中心组成的大型多专业团体诊所。采用随机对照研究设计，该研究有三个具体目标： 1)使用计算机化的临床信息系统来确定适当评估和治疗第三和第四阶段慢性肾脏疾病的基线预测因素，包括患者特征和涉及肾脏的情况 2)评估3期慢性肾脏疾病的护理质量是否可以在18个月内通过a)向初级保健医生推荐适合风险的护理的电子警报和b)向提供自我管理支持材料的患者发送季度邮件相结合来显著改善 3)评估干预成分的使用与初级保健医生对慢性肾脏疾病管理和电子提醒系统的态度之间的关系。 这项研究对如何在初级保健环境下优化门诊慢性肾脏疾病患者的治疗具有重要意义。通过这样做，它将提供一个模型，说明全国各地的门诊实践如何使用健康信息技术和电子健康记录来对患有慢性病的大量患者进行风险分层，并有效地将护理点警报与患者外联结合起来。

DESCRIPTION (provided by applicant): Chronic kidney disease affects over 25 million Americans and is associated with significant patient morbidity and mortality, as well as high health care costs. Primary care represents the front line in the early identification and management of chronic kidney disease. Unfortunately, this disease remains unrecognized, both by primary care physicians and their patients; leading to suboptimal quality of care and poor health outcomes. This study will evaluate electronic alerts to risk stratify patients with chronic kidney disease and present targeted treatment recommendations to primary care physicians within an electronic health record. The intervention will take place at Harvard Vanguard Medical Associates, a large multispecialty group practice consisting of 14 health centers in eastern Massachusetts. With a randomized, controlled study design, the study has three specific aims: 1) To use computerized clinical information systems to identify baseline predictors of appropriate evaluation and treatment of Stages 3 and 4 chronic kidney disease, including patient characteristics and nephrology involvement 2) To assess whether quality of care for stage 3 chronic kidney disease can be substantially improved over 18 months by the combination of a) point of care electronic alerts to primary care physicians recommending risk-appropriate care, and b) quarterly mailings to patients providing self management support materials 3) To assess the relationship between utilization of the intervention components and primary care physician attitudes towards chronic kidney disease management and electronic reminder systems. This study has important implications for how the treatment of outpatients with chronic kidney disease can be optimized in the primary care setting. In doing this, it will provide a model for how ambulatory practices across the country can use health information technology and electronic health records to risk stratify large patient populations with chronic disease, and combine both point-of-care alerts with patient outreach in an efficient manner.