Health IT Enhanced for CKD in Safety-Net Primary Care

安全网初级保健中针对 CKD 的健康 IT 增强

基本信息

批准号：
8231935
负责人：
NEIL R. POWE
金额：
$ 23.14万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-30 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8231935
关键词：
Address Adoption Adult Albuminuria Angiotensin Receptor Angiotensin-Converting Enzyme Inhibitors Awareness Blood Pressure Cardiovascular system Caring Chronic Chronic Disease Chronic Kidney Failure Clinic Clinical Clinical Trials Communication Community Health Complex Computers Decision Making Diabetes Mellitus Disease Disease Management Disease Progression Education Educational Materials Environment Epidemic Excess Mortality Feedback Fostering Glomerular Filtration Rate Glycosylated hemoglobin A Goals Grant Health Health Communication Health Status Health system Healthcare Systems Hypotension Information Technology Institution Intervention Knowledge Knowledge Discovery Life Style Maintenance Metabolic Minority Morbidity - disease rate Notification Outcome Patients Peptidyl-Dipeptidase A Population Primary Health Care Program Sustainability Provider Randomized Registries Research Research Design Resources Risk Reduction Behavior Self Management System Telephone Testing Translating Underserved Population United States Ursidae Family Vulnerable Populations Work base blood pressure regulation burden of illness chronic care model disease registry evidence base evidence based guidelines experience follow-up health care delivery health information technology health literacy high risk improved kidney disease education mortality patient population prevent primary outcome programs prospective randomized trial research study response safety net social cognitive theory successful intervention therapy adherence treatment strategy

项目摘要

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) is common in U.S. adults and is associated with excess mortality and morbidity. Better management could slow progression of disease, prevent metabolic complications, and reduce cardiovascular outcomes. However, low patient and provider awareness of CKD, inadequate knowledge of treatment strategies, and ineffective patient-provider communication can impede such efforts. We propose to evaluate an incrementally intensive set of interventions to enhance awareness, improve knowledge, and foster better communication, possibly leading to better clinical outcomes. The interventions, based on the Chronic Care Model and Social Cognitive Theory, will be evaluated in a high-risk, underserved population seeking primary care at 10 community health clinics, using a prospective randomized trial nested in a quasi- experimental study design. In four clinics, we will introduce an automated CKD registry incorporating decision support, which will identify patients with CKD, send notifications to providers, and provide educational materials to patients and providers (Basic CKD Registry). In six additional clinics, we will introduce the Enhanced CKD Registry, which will include all the components of the Basic CKD Registry, augmented with claims-based surveillance of care and care team feedback. We will randomize patients in these six clinics to either 1) the Enhanced CKD Registry intervention or 2) the Enhanced CKD Registry Plus, which includes an additional patient-level intervention: automated telephone calls offering CKD education and self-management support, with need-based follow-up by a health coach who communicates with the care team. We will compare our primary outcome, change in blood pressure, pre- vs. post-implementation of the Basic CKD Registry; between patients in the Enhanced vs. Basic CKD Registry; and between patients in the Enhanced CKD Registry Plus vs. the Enhanced CKD Registry. We will also examine secondary clinical (e.g., albuminuria, HbA1c), intermediate (e.g., awareness, activation, ACE/ARB use), and sustainability (e.g., reach, adoption, maintenance) outcomes. This proposal unites a large safety-net health system for patients at high risk for CKD progression and complications to address barriers to improved CKD management. Successful interventions can be extended throughout our larger healthcare system, on a wider scale in similar safety-net systems, and in patient populations with less complex clinical profiles. Thus, this study has important implications for improving the health status of CKD patients in the United States. PUBLIC HEALTH RELEVANCE: Chronic kidney disease, which is associated with significant morbidity and mortality, is highly prevalent in the United States, particularly among underserved populations. Improving disease awareness and health communication and maintaining active surveillance through tailored, proactive health IT can improve health outcomes among patients with CKD via activation of patients and providers and engagement in risk-reduction behaviors.

描述（由申请人提供）：慢性肾病（CKD）在美国成年人中很常见，并且与过高的死亡率和发病率相关。更好的管理可以减缓疾病进展、预防代谢并发症并减少心血管结局。然而，患者和提供者对 CKD 的认识较低、治疗策略知识不足以及患者与提供者沟通不力可能会阻碍此类努力。我们建议评估一套渐进强化的干预措施，以提高认识、增进知识并促进更好的沟通，从而可能带来更好的临床结果。这些干预措施基于慢性护理模型和社会认知理论，将使用准实验研究设计中的前瞻性随机试验，对在 10 个社区卫生诊所寻求初级保健的高风险、服务不足的人群进行评估。在四家诊所中，我们将引入包含决策支持的自动化 CKD 登记处，该登记处将识别 CKD 患者，向提供者发送通知，并向患者和提供者提供教育材料（基本 CKD 登记处）。在另外六个诊所中，我们将推出增强型 CKD 登记系统，其中包括基本 CKD 登记系统的所有组成部分，并通过基于索赔的护理监测和护理团队反馈进行增强。我们将把这六个诊所的患者随机分配到 1) 增强型 CKD 登记干预或 2) 增强型 CKD 登记增强版，其中包括额外的患者级别干预：自动电话提供 CKD 教育和自我管理支持，并满足需要-由与护理团队沟通的健康教练进行后续跟进。我们将比较基本 CKD 登记系统实施前与实施后的主要结果、血压变化；增强型 CKD 登记库与基本型 CKD 登记库中的患者之间；以及增强型 CKD 登记系统 Plus 与增强型 CKD 登记系统中的患者之间的比较。我们还将检查次要临床（例如蛋白尿、HbA1c）、中间（例如认知、激活、ACE/ARB 使用）和可持续性（例如覆盖、采用、维持）结果。该提案为 CKD 进展和并发症高风险患者联合建立了一个大型安全网卫生系统，以解决改善 CKD 管理的障碍。成功的干预措施可以扩展到我们更大的医疗保健系统、更广泛的类似安全网系统以及临床特征不太复杂的患者群体。因此，这项研究对于改善美国 CKD 患者的健康状况具有重要意义。公共卫生相关性：慢性肾脏病与显着的发病率和死亡率相关，在美国非常普遍，特别是在服务不足的人群中。通过定制、主动的健康 IT 提高疾病意识和健康沟通并保持主动监测，可以通过激活患者和提供者以及参与降低风险的行为来改善 CKD 患者的健康结果。