Optimizing Electronic Alerts for Acute Kidney Injury

优化急性肾损伤的电子警报

• 批准号: 10337243
• 负责人: FRANCIS PERRY WILSON
• 金额: $ 59.76万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10337243
• 关键词: Acute Renal Failure with Renal Papillary Necrosis; Address; Adopted; Agreement; Behavior; Bioethics; Cardiovascular Diseases; Caring; Cessation of life; Chronic Kidney Failure; Clinical; Clinical Trials; Complication; Coupled; Data; Development; Diagnosis; Diagnostic; Dialysis procedure; Effectiveness; Engineering; Enrollment; Ensure; Evaluation; Event; Exposure to; Face; Failure; Fatigue; Foundations; Future; Goals; Great Britain; Guidelines; Health Care Costs; Health system; Hospital Mortality; Hospitalization; Hospitals; Individual; Informed Consent; Infrastructure; Injury to Kidney; Institutes; Institutional Review Boards; Intelligence; International; Intervention; Lead; Literature; Medicine; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; Multicenter Trials; National Health Services; Network-based; Non-Steroidal Anti-Inflammatory Agents; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Population; Principal Investigator; Proliferating; Provider; Publishing; Randomized; Recommendation; Research; Risk; Secure; Series; System; Techniques; Testing; Therapeutic; Time; United Kingdom; United States; Update; Urinalysis; Work; base; care outcomes; clinical efficacy; design; dosage; experience; improved; improved outcome; mortality; mortality risk; nephrotoxicity; neural network; personalized medicine; predictive modeling; prevent; provider behavior; randomized trial; trial design; waiver

Project Summary The overarching goal of this proposal is to determine how alerts for acute kidney injury (AKI) can be engineered to provide benefit to patients and whether that benefit can be enhanced with intelligent targeting. AKI is a common complication in hospitalized patients, and carries with it a substantially increased risk of morbidity and mortality. International guidelines suggest prompt diagnostic evaluation and avoidance of nephrotoxins once AKI develops, but multiple studies and our preliminary data have documented that the diagnosis of AKI is often delayed or missed altogether. Even when recognized, diagnostic actions (such as urinalysis) and therapeutic actions (such as discontinuing potentially nephrotoxic agents) are infrequently taken. Failure to engage in best practices is associated with increased morbidity and mortality among AKI patients. The lack of recognition of AKI, and its direct clinical consequences, has prompted several health systems in the US and the entire National Health Service of Great Britain to institute automated, electronic alerts for AKI. However, our pilot randomized trial of a basic alert system did not demonstrate a significant benefit of alerting for AKI on clinical outcomes such as progression of AKI, dialysis, or death. This proposal describes studies that build on our prior experience to determine how AKI alerts coupled with clinical best practice actions, and intelligent targeting of those alerts, can improve care and patient outcomes across multiple centers. We have designed a series of large, multi-center randomized trials of AKI alerts to identify modes of delivery and targeting that will best improve the care and clinical outcomes of patients. Across 6 hospitals, with a total of more than 10,000 AKI cases per year, we will evaluate 1) the clinical efficacy of an AKI alert tied to a clinical best practices order set, 2) whether targeting alerts to patients who have received specific drug-classes can modify prescription behavior and improve patient outcome and 3) whether progressive targeting of alerts through the use of uplift modeling can increase effectiveness while decreasing alert fatigue. In support of this application, we have collected preliminary data regarding the rates and outcomes of AKI at the study hospitals. We have also documented surprisingly low rates of potentially nephrotoxic-drug discontinuation among those with AKI. In addition, we have reanalyzed data from our original pilot alert trial to demonstrate that uplift modeling can be used to identify individuals most likely to benefit from alerts. This predictive modeling approach is an example of personalized medicine, where large amounts of patient data are used to target alerts to a narrow population, avoiding unnecessary alerting and thus reducing alert fatigue. Beyond informing the use of AKI alerts in the future, these studies will provide an infrastructure and a statistical foundation for the rigorous assessment and targeting of best-practice alerts across multiple fields of medicine.

项目摘要 该提案的总体目标是确定急性肾脏损伤的警报（AKI）如何 旨在为患者提供好处，以及是否可以通过智能靶向来增强这种益处。 AKI是住院患者的常见并发症，并带有大幅增加的风险 发病率和死亡率。国际准则建议及时诊断评估和避免 肾毒素一旦AKI发展，但是多次研究和我们的初步数据证明了 AKI的诊断通常被延迟或完全错过。即使被认可，诊断动作（例如 尿液分析）和治疗作用（例如停止潜在的肾毒性剂）很少 拍摄。未能从事最佳实践与AKI的发病率和死亡率增加有关 患者。缺乏对AKI及其直接临床后果的认识，促使几种健康 美国和整个英国的全国卫生局的系统，以建立自动化的电子 警报AKI。但是，我们对基本警报系统的试点随机试验并未证明重要 提醒AKI临床结果的好处，例如AKI，透析或死亡的进展。这个建议 描述基于我们先前经验的研究，以确定AKI如何提醒临床最佳 练习措施以及这些警报的明智目标可以改善护理和患者的结果 多个中心。 我们设计了一系列大型，多中心的随机试验，以确定 分娩和靶向将最能改善患者的护理和临床结果。在6家医院 每年总共有10,000多个AKI案件，我们将评估1）与A KI警报的临床功效 临床最佳实践订单集，2）是否针对接受特定毒品类的患者的警报是否针对 可以修改处方行为并改善患者的结果，3）是否逐步定位警报 通过使用隆升建模可以提高效力，同时减少警报疲劳。 为了支持此应用程序，我们收集了有关费率和结果的初步数据 Aki在研究医院。我们还记录了可​​能较低的潜在肾毒性药物的速率 有AKI的人中断。此外，我们还从原始的试点警报试验中重新分析了数据 证明可以使用隆升建模来识别最有可能从警报中受益的个人。这 预测建模方法是个性化医学的一个例子，其中大量患者数据是 用于针对狭窄人群的警报，避免不必要的警报，从而减少警报疲劳。 除了告知未来AKI警报的使用外，这些研究还将提供基础架构和统计 对多个医学领域的最佳实践警报进行严格评估和定位的基础。

项目成果

Novel Risk Factors for Progression of Diabetic and Nondiabetic CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.

• DOI: 10.1053/j.ajkd.2020.07.011
• 发表时间: 2021-01
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Anderson AH;Xie D;Wang X;Baudier RL;Orlandi P;Appel LJ;Dember LM;He J;Kusek JW;Lash JP;Navaneethan SD;Ojo A;Rahman M;Roy J;Scialla JJ;Sondheimer JH;Steigerwalt SP;Wilson FP;Wolf M;Feldman HI;CRIC Study Investigators
• 通讯作者: CRIC Study Investigators

Electronic Health Record Embedded Strategies for Improving Care of Patients With Heart Failure.

电子健康记录嵌入式策略可改善心力衰竭患者的护理。

• DOI: 10.1007/s11897-023-00614-0
• 发表时间: 2023
• 期刊: Current heart failure reports
• 作者: Fuery,MichaelA;Kadhim,Bashar;Samsky,MarcD;Freeman,JamesV;Clark,Katherine;Desai,NiharR;Wilson,FrancisP;Ahmed,Treeny;Ahmad,Tariq
• 通讯作者: Ahmad,Tariq

Empagliflozin in Heart Failure: Regional Nephron Sodium Handling Effects.

恩格列净治疗心力衰竭：区域肾单位钠处理作用。

• DOI: 10.1681/asn.0000000000000269
• 发表时间: 2024
• 期刊: Journal of the American Society of Nephrology : JASN
• 作者: Rao,VeenaS;Ivey-Miranda,JuanB;Cox,ZacharyL;Moreno-Villagomez,Julieta;Maulion,Christopher;Bellumkonda,Lavanya;Chang,John;Field,MPaul;Wiederin,DanielR;Butler,Javed;Collins,SeanP;Turner,JeffreyM;Wilson,FPerry;Inzucchi,Silvi
• 通讯作者: Inzucchi,Silvi