Improving Recognition and Management of Chronic Kidney Disease in Primary Care

描述（由申请人提供）：该职业发展奖扩展了候选人目前在卫生服务研究领域的经验，包括使用电子病历提高质量。该奖项将进一步关注候选人在质量改进和卫生信息技术（HIT）领域的职业发展。该应用程序的所有目标都旨在为候选人提供必要的培训，使其成为如何最有效地利用HIT来改善优质医疗保健服务的专家。该奖项为期四年的短期目标是使候选人成为一名独立的研究者，能够领导大规模的质量改进项目，并指导基于初级保健实践的研究网络（PBRN）。在此奖励期内，候选人计划根据本项目的研究成果发表5-7篇论文。在此奖励期结束时，候选人还希望获得后续赠款支持，以广泛实施和评估临床决策支持（CDS）工具在慢性病管理方面的效用。本申请中提出的培训活动包括由成功的卫生服务研究人员继续进行监督指导，课程包括获得医学信息学研究生证书，以及在研讨会和国家会议上展示研究成果。研究计划中提出的活动的目的是确定在美国各地的初级保健实践中改善慢性肾脏疾病（CKD）患者的识别和后续管理的方法，重点是如何利用HIT，更具体地说，是电子病历中嵌入的CDS工具来实现这一目标。这些计划活动的结果可能适用于任何慢性疾病。该奖项研究计划的具体目标包括(1)为初级保健选择一套CKD质量指标，(2)将这些CKD指标纳入PBRN内分发给初级保健实践的季度实践绩效报告中，(3)开发可用于加强初级保健中CKD患者护理的CDS工具。(4)在这些实践中使用经过验证的干预措施实施和评估这些临床决策支持工具的影响。该奖项旨在解决医疗保健研究和质量机构（AHRQ）的使命，即为所有美国人提高医疗保健的质量、安全、效率和有效性，主要是为了解决AHRQ的“卫生信息技术”优先领域的兴趣，特别是解决如何使用HIT来改善医疗保健决策。此外，由于患者教育和处方建议都是计划干预的组成部分，该项目还将涉及以下研究领域：(1)HIT以提高药物管理的质量和安全性；(2)HIT以支持以患者为中心的护理。此外，尽管对AHRQ感兴趣的HIT领域做出了回应，但该研究计划也与AHRQ的其他投资组合保持一致，包括比较有效性、预防和护理管理、创新和新兴思想。与AHRQ的目标一致，该研究项目旨在提高所有美国人的医疗保健质量，并促进循证决策。

DESCRIPTION (provided by applicant): This career development award expands upon the candidate's current experience in areas of health services research including improving quality using electronic medical records. The award will further focus the candidate's career development in the areas of quality improvement and health information technology (HIT). All of the goals of this application have been designed to provide the candidate with the training necessary to become an expert on how HIT can be most effectively utilized to improve the delivery of quality healthcare. The short term goal for the four year course of this award is for the candidate to become an independent investigator, capable of leading large scale quality improvement projects and directing a primary care practice-based research network (PBRN). During this award period, the candidate plans to publish 5-7 manuscripts based on the results of this research project. By the end of this award period, the candidate also expects to have obtained subsequent grant support to broadly implement and assess the utility of clinical decision support (CDS) tools on the management of chronic diseases. Training activities proposed in this application include continued supervised mentoring by successful health services researchers, coursework including obtaining a Graduate Certificate in Medical Informatics, and presentation of findings at both seminars and national meetings. The purpose of the activities proposed in the research proposal is to identify methods to improve the identification and subsequent management of patients with chronic kidney disease (CKD) in primary care practices across the United States, focusing on how HIT, and more specifically CDS tools embedded in an electronic medical record, can be employed to achieve this goal. The findings from these planned activities are likely to be applicable to any chronic disease. The specific aims for the research plan for this award include (1) selecting a set of CKD quality indicators for primary care, (2) incorporating these CKD indicators in quarterly practice performance reports distributed to primary care practices within a PBRN, (3) developing CDS tools that can be used to enhance care of patients with CKD in primary care, and (4) implementing and evaluating the impact of these clinical decision support tools in ten of these practices using validated interventions. This award addresses the Agency for Healthcare Research and Quality's (AHRQ) mission to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans, and is primarily intended to address the AHRQ's "Health Information Technology" priority area of interest, particularly addressing how HIT can be used to improve health care decision making. In addition, since both patient education and prescribing recommendations are a component of the planned intervention, the project will also address research areas (1) HIT to improve the quality and safety of medication management and (2) HIT to support patient-centered care. Moreover, although responsive to the AHRQ's HIT area of interest, this research plan is also consistent with other AHRQ portfolios, including comparative effectiveness, prevention and care management, and innovations and emerging ideas. Consistent with AHRQ's goals, the research project is designed to improve the quality of healthcare for all Americans and to promote evidence-based decision making. PUBLIC HEALTH RELEVANCE: Because chronic kidney disease affects a significant proportion of the population, and early interventions can reduce subsequent risks for progressive renal and cardiovascular disease, the interventions to improve the identification and management of patients with early chronic kidney disease which are developed during this research project could have a major public health impact. This research project will also clarify how health information technology, particularly clinical decision support tools, can most effectively be used to improve primary care practice. In addition, since physician reimbursement for electronic medical record use will likely soon require use of clinical decision support tools, the project may also have health policy importance and relevance for many practicing physicians.