Chronic Kidney Disease
Conditions
Keywords
chronic kidney disease, clinical alerts, late referral, electronic medical record, Computerized clinical decision support systems (CDSS)
Brief summary
To determine whether the use of educational sessions and computerized clinical reminders can improve primary care doctors' delivery of care to CKD patients compared to educational sessions alone. Hypothesis: Clinical reminders will improve the care delivered to CKD patients
Detailed description
Literature supports that most chronic kidney disease (CKD) patients are cared for by primary care physicians (PCP) without the help of a kidney specialist. Many of these patients fail to achieve targeted outcomes and late referral to a nephrologist has been associated with an increased risk of death. Automated computerized clinical reminders have been shown to improve physician compliance with recommended guidelines in other settings. Aims: To determine if clinical reminders can help PCPs decrease the rate of late referrals, improve urine albumin checks in CKD patients Design: prospective randomized controlled, single-blinded study with additional historical control Methods: Two 20-minute teaching sessions aimed at all GIM PCPs in the UPMC clinic followed by randomization of the eligible GIM providers to receive automated clinical reminders (CR) for their CKD stage 3b-5 patients versus routine care. Outcomes: Using a database search, individuals with an eGFR\<45ml/min/1.73m2 (not seen by a nephrologist) will have data collected on: PCP referral to a nephrologist, urinary albumin (or protein) quantification in the past year, PCP recognition of patients with eGFR\<45ml/min, ACE/ARB usage.
Interventions
OTHERautomated clinical alerts
automated clinical alerts in the electronic medical record
OTHERprovider education
PCP education session on CKD
Sponsors
University of Pittsburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* For PCPs: all GIM attending physicians with a weekly continuity clinic. * For patients: \>= 18 years-old with an eGFR\<45ml/min/1.73m2 being seen in the UPMC GIM clinic by a faculty member during the 10-month intervention period
Exclusion criteria
* for PCPs: imminent plans to leave the department * patients with a renal transplant, on any form of dialysis, or with a previous nephrology evaluation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| referral to a nephrologist | 12 months | Referral to a nephrologist within the 12 months following decision support system activation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Use of ACE/ARB | 12 months | Active use of ACE/ARB at the end of the 12 month period following decision support system activation. |
| Annual ACR or PCR check | 12 months | ACR or PCR within 12months of the decision support system activation |
Countries
United States
Outcome results
None listed