Evaluating the Impact of Guidelines on Physician Prescription Practices in Chronic Kidney Disease

摘要 心血管疾病是慢性肾脏病患者发病和死亡的主要原因 病（CKD）。尽管有证据和临床实践指南支持使用他汀类药物， 需要非透析的慢性肾病患者心血管风险降低，他汀类处方的流行率 CKD患者的发病率仍然很低。增加他汀类药物使用的策略是一个重要的机会 改善这一人群的心血管预后。目前他汀类药物使用率低的原因 仍然不清楚，因此阐明这些原因将是重要的通知设计的成功 执行战略。 该提案的具体目标是检查影响他汀类药物使用率的不同因素 CKD患者中的处方。目标1将评估临床实践指南变化的影响 通过使用全国代表性的 数据库目标2和3将检查可能影响他汀类药物处方的更细粒度的提供者水平因素 (i.e.,肾脏护理对心血管风险管理的贡献，初级保健提供者（PCP） 了解预防性心血管护理指南，PCP对CKD患者心血管风险的认知 患者），并将其与个人实践行为相关联，使用来自旧金山弗朗西斯科健康中心的数据。 网络，一个地方公共卫生系统，不成比例地照顾社会经济地位低的个人。 研究设计将涉及对大型国家数据集（国家卫生和健康数据集）的横截面分析。 营养检查调查; NHANES）的Aim 1和来自一个人的电子健康记录的本地数据集 保健提供系统（旧金山弗朗西斯科保健网），目标2和3。目标3还将包括调查 当地初级保健提供者评估对指南的认识和对心血管风险的看法 CKD患者。

ABSTRACT Cardiovascular disease is the leading cause of morbidity and mortality among individuals with chronic kidney disease (CKD). Despite evidence and clinical practice guidelines supporting the use of statins for cardiovascular risk reduction in non-dialysis requiring chronic kidney disease, prevalence of statin prescription among individuals with CKD remains low. Strategies to increase statin use represent an important opportunity to improve cardiovascular outcomes for this population. Reasons underlying the current low rates of statin use remain unclear, thus elucidating these reasons will be important for informing the design of successful implementation strategies. The specific aims of this proposal are intended to examine different factors that influence rates of statin prescription among individuals with CKD. Aim 1 will assess the impact of changes in clinical practice guidelines by examining temporal trends in statin use among individuals with CKD using a nationally representative database. Aims 2 and 3 will examine more granular provider-level factors that may influence statin prescription (i.e., the contribution of nephrology care to cardiovascular risk management, primary care provider (PCP) knowledge of preventive cardiovascular care guidelines, PCP perception of cardiovascular risk in CKD patients) and correlate them with individual practice behaviors, using data from the San Francisco Health Network, a local public health system that disproportionately cares for individuals of low socioeconomic status. The study design will involve cross-sectional analyses of both a large national dataset (the National Health and Nutrition Examination Survey; NHANES) for Aim 1 and a local dataset from the electronic health record of one health delivery system (San Francisco Health Network) for Aims 2 and 3. Aim 3 will also involve a survey of local primary care providers to assess awareness of guidelines and perceptions of cardiovascular risk pertinent to CKD patients.