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.

项目概要 该提案的首要目标是确定如何发出急性肾损伤 (AKI) 警报 旨在为患者带来益处，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，并且伴随着 AKI 的风险大大增加 发病率和死亡率。国际指南建议及时进行诊断评估并避免 一旦发生 AKI，就会产生肾毒素，但多项研究和我们的初步数据证明， AKI 的诊断常常被延迟或完全漏诊。即使被识别，诊断行动（例如 尿液分析）和治疗措施（例如停用潜在的肾毒性药物）很少 采取。未能采用最佳实践与 AKI 发病率和死亡率增加相关 患者。对 AKI 及其直接临床后果缺乏认识，已促使许多健康 美国和整个英国国家卫生服务系统建立自动化、电子化 AKI 警报。然而，我们对基本警报系统的随机试点试验并未显示出显着的效果。 AKI 警报对临床结果（如 AKI 进展、透析或死亡）的好处。这个提议 描述了基于我们先前经验的研究，以确定 AKI 警报如何与临床最佳结合 实践行动以及这些警报的智能定位可以改善整个护理和患者的治疗结果 多个中心。 我们设计了一系列针对 AKI 警报的大型、多中心随机试验，以确定 AKI 警报的模式 交付和靶向将最好地改善患者的护理和临床结果。横跨6家医院， 每年总共超过 10,000 例 AKI 病例，我们将评估 1) 与 临床最佳实践命令集，2) 是否针对已接受特定药物类别的患者发出警报 可以改变处方行为并改善患者的治疗结果，3) 是否逐步针对警报 通过使用提升模型可以提高效率，同时减少警觉疲劳。 为了支持这项申请，我们收集了有关比率和结果的初步数据 研究医院发生 AKI。我们还记录了潜在肾毒性药物的发生率低得惊人 患有 AKI 的患者应停药。此外，我们还重新分析了最初试点警报试验的数据 证明提升模型可用于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疗的一个例子，其中大量的患者数据 用于针对少数人群发出警报，避免不必要的警报，从而减少警报疲劳。 除了为未来 AKI 警报的使用提供信息外，这些研究还将提供基础设施和统计数据 为跨多个医学领域的最佳实践警报进行严格评估和定位奠定了基础。

项目成果

A Comparison Study of Coronavirus Disease 2019 Outcomes in Hospitalized Kidney Transplant Recipients.

住院肾移植受者 2019 年冠状病毒病结果的比较研究。

• DOI: 10.34067/kid.0005652020
• 发表时间: 2021-01-12
• 期刊: Kidney360
• 作者: Sherry G. Mansour;D. Malhotra;M. Simonov;Yu Yamamoto;T. Arora;Labeebah Subair;Jameel Alausa;D. Moledina;J. Greenberg;F. Wilson;Ethan P. Marin
• 通讯作者: Ethan P. Marin

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。

• 发表时间: 2024-02-01
• 作者: Rao, Veena S;Ivey;Cox, Zachary L;Moreno;Maulion, Christopher;Bellumkonda, Lavanya;Chang, John;Field, M Paul;Wiederin, Daniel R;Butler, Javed;Collins, Sean P;Turner, Jeffrey M;Wilson, F Perry;Inzucchi, Silvi
• 通讯作者: Inzucchi, Silvi

Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure: The REVEAL-HF Randomized Clinical Trial.

提醒临床医生注意心力衰竭住院患者的 1 年死亡率风险：REVEAL-HF 随机临床试验。

• 发表时间: 2022-09-01
• 影响因子: 24
• 作者: Ahmad, Tariq;Desai, Nihar R;Yamamoto, Yu;Biswas, Aditya;Ghazi, Lama;Martin, Melissa;Simonov, Michael;Dhar, Ravi;Hsiao, Allen;Kashyap, Nitu;Allen, Larry;Velazquez, Eric J;Wilson, F Perry
• 通讯作者: Wilson, F Perry

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。

• 发表时间: 2023-08
• 作者: Fuery, Michael A;Kadhim, Bashar;Samsky, Marc D;Freeman, James V;Clark, Katherine;Desai, Nihar R;Wilson, Francis P;Ahmed, Treeny;Ahmad, Tariq
• 通讯作者: Ahmad, Tariq

In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility.

急性失代偿性心力衰竭治疗后口服利尿剂的院内观察：评估效用。

• 发表时间: 2023-04
• 作者: Ivey;Rao, Veena S;Cox, Zachary L;Moreno;Mahoney, Devin;Maulion, Christopher;Bellumkonda, Lavanya;Turner, Jeffrey M;Collins, Sean;Wilson, F Perry;Krumholz, Harlan M;Testani, Jeffrey M
• 通讯作者: Testani, Jeffrey M