Health Information Technology for Chronic Kidney Disease Management

慢性肾脏病管理的健康信息技术

基本信息

批准号：
8581405
负责人：
Lipika Samal
金额：
$ 18.43万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8581405
关键词：
Albumins American Award Bicarbonates Biometry Boston Calcium Caring Chronic Chronic Kidney Failure Clinic Clinical Clinical Trials Commit Computers Consensus Creatinine Data Data Collection Development Plans Diagnosis Dialysis procedure Disease Disease Management Early Diagnosis Early treatment End stage renal failure Enrollment Ensure Environment Epidemiologist Epidemiology FarGo Funding Goals Growth Health Care Costs Healthcare Systems Heart Hemodialysis Hospitals Human Informatics Information Systems Inherited Institutes Internal Medicine Internist Intervention K-Series Research Career Programs Kidney Kidney Diseases Laboratories Light Literature Manuals Massachusetts Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Modeling Monitor Nephrology Outcome Patients Physicians Primary Care Physician Primary Health Care Public Health Reporting Research Research Methodology Research Personnel Research Project Grants Resource Informatics Risk Serum Serum Albumin Societies Staging Structure Systemic disease Testing Time Training Translational Research Urine Woman Work career career development cohort computerized tools cooking cost design disease diagnosis electronic data health information technology high risk improved innovation inorganic phosphate novel point of care prevent primary care setting primary outcome public health relevance randomized trial response routine care satisfaction secondary outcome success tool usability user-friendly

项目摘要

DESCRIPTION (provided by applicant): This is an application for a K23 Career Development Award for Dr. Lipika Samal, a general internist at Brigham and Women's Hospital (BWH) in Boston, Massachusetts. Dr. Samal is establishing herself as an investigator in health information technology (HIT) to improve outcomes in patients with chronic kidney disease (CKD). Her career goal is to become an independently funded clinician investigator. This K23 award will help her to accomplish the following goals: 1) to obtain advanced training in biostatistics, epidemiology, and HIT research methodology, 2) to improve clinical expertise in management of CKD, 3) to develop and implement an HIT intervention in primary care clinics to improve monitoring, treatment, and referral for patients with CKD, and 4) to develop as an investigator to ensure transition to independent funding status. To achieve these goals, Dr. Samal has chosen a mentoring team committed to her success as a clinician investigator. Her primary mentor is Dr. David Bates, Chief of General Internal Medicine at BWH and an internationally renowned HIT researcher. Her secondary mentors are Dr. Sushrut Waikar, a nephrologist and clinical researcher, and Dr. Jeffrey Linder, a primary care physician and HIT researcher. She will also receive guidance from Dr. Joseph Bonventre, Chief of the Renal Division at BWH and past President of the American Society of Nephrology, as well as Dr. Thomas Sequist, a primary care physician and CKD researcher, biostatistician Dr. John Orav, and epidemiologist Dr. Francis Cook. A large proportion of patients with CKD receive care in primary care clinics, so interventions in the primary care setting are important for delaying progression to end stage renal disease (ESRD). HIT systems can prompt early diagnosis of CKD and can help physicians to stratify patients according to risk of progression to ESRD. Despite this, relatively few studies have been done leveraging HIT in CKD management as compared to other chronic conditions. We propose to develop and evaluate an innovative HIT tool for CKD management in primary care clinics. Our specific aims are as follows. Specific Aim 1: Develop an HIT application to calculate risk of progression to ESRD according to a risk prediction model developed by Tangri, et. al.; Specific Aim 1a: Develop a search method to find existing urine albumin to creatinine ratio, serum calcium, serum phosphate, serum albumin, and serum bicarbonate values. Validate the search method through manual chart review; Specific Aim 1b: Prepare for implementation of the HIT application by i) designing a user interface after gathering PCP input, ii) conducting usability testing, and iii) convening an interdisciplinary pane to determine a risk threshold for referral within our healthcare system; Specific Aim 2: Conduct a cluster randomized trial to determine the effect of the HIT application on the primary outcome: the completion of the necessary tests for the risk prediction model (urine albumin to creatinine ratio, serum calcium, serum phosphate, serum albumin, and serum bicarbonate) for CKD patients in primary care. Secondary outcomes will include nephrology referrals; doubling of serum creatinine; initiation of hemodialysis; and PCP satisfaction. The clinical trial enrollment and data collection will rely on electronic data collected during routine care, a low-cost, feasibl approach to research. The candidate's epidemiology and informatics background, mentorship, and strong environment of informatics resources make these specific aims attainable during the award period. Most patients with CKD are cared for in primary care settings. Early stage management is suboptimal, and this represents a significant public health problem. The most important end result of this study is a proof of concept that a risk prediction model with laboratory results "built-in" can promote appropriate nephrology referral. The human-centered research in Aim 1 will contribute to a user-friendly HIT tool for this project and will contribute o the literature on primary care HIT interventions. The results from Aim 2 will contribute to preliminary data for an R01 with nephrology referral as the primary outcome. The research performed during the K23 period will inform a subsequent R01 focused on improving additional aspects of CKD management in ambulatory clinics, which is a form of translational research. This information may be useful in future research on improving CKD care in general, and is applicable to other renal diseases including other systemic diseases, inherited diseases, or any form of CKD where monitoring and treatment initially occurs in the primary care setting.

描述（由申请人提供）：这是马萨诸塞州波士顿布莱根妇女医院 (BWH) 的普通内科医生 Lipika Samal 博士的 K23 职业发展奖申请。 Samal 博士正在将自己定位为健康信息技术 (HIT) 领域的研究者，以改善慢性肾脏病 (CKD) 患者的治疗结果。她的职业目标是成为一名独立资助的临床研究者。该 K23 奖项将帮助她实现以下目标：1) 获得生物统计学、流行病学和 HIT 研究方法方面的高级培训，2) 提高 CKD 管理的临床专业知识，3) 在初级保健中制定和实施 HIT 干预措施护理诊所，以改善 CKD 患者的监测、治疗和转诊，以及 4) 发展成为研究者，以确保向独立资助状态的过渡。为了实现这些目标，Samal 博士选择了一个致力于帮助她作为临床研究者取得成功的指导团队。她的主要导师是 BWH 普通内科主任、国际知名 HIT 研究员 David Bates 博士。她的第二导师是肾脏病学家和临床研究员 Sushrut Waikar 博士，以及初级保健医生和 HIT 研究员 Jeffrey Linder 博士。她还将接受 BWH 肾脏科主任、美国肾脏病学会前主席 Joseph Bonventre 博士以及初级保健医生和 CKD 研究员 Thomas Sequist 博士、生物统计学家 John Orav 博士的指导。和流行病学家弗朗西斯·库克博士。很大一部分 CKD 患者在初级保健诊所接受治疗，因此初级保健机构的干预对于延缓进展为终末期肾病 (ESRD) 非常重要。 HIT 系统可以促进 CKD 的早期诊断，并可以帮助医生根据进展为 ESRD 的风险对患者进行分层。尽管如此，与其他慢性病相比，利用 HIT 治疗 CKD 的研究相对较少。我们建议开发和评估一种创新的 HIT 工具，用于初级保健诊所的 CKD 管理。我们的具体目标如下。具体目标 1：开发 HIT 应用程序，根据 Tangri 等人开发的风险预测模型计算进展为 ESRD 的风险。等；具体目标 1a：开发一种搜索方法来查找现有的尿白蛋白与肌酐比、血清钙、血清磷酸盐、血清白蛋白和血清碳酸氢盐值。通过手动图表审核验证搜索方法；具体目标 1b：准备实施 HIT 应用程序，方法是：i) 在收集 PCP 意见后设计用户界面，ii) 进行可用性测试，以及 iii) 召集跨学科小组以确定在我们的医疗保健系统内转诊的风险阈值；具体目标 2：进行整群随机试验，以确定 HIT 应用对主要结果的影响：完成风险预测模型的必要测试（尿白蛋白与肌酐比、血清钙、血清磷酸盐、血清白蛋白和血清碳酸氢盐）用于初级保健中的 CKD 患者。次要结果将包括肾脏病转诊；血清肌酐加倍；开始血液透析；和 PCP 满意度。临床试验的招募和数据收集将依赖于常规护理期间收集的电子数据，这是一种低成本、可行的研究方法。候选人的流行病学和信息学背景、指导以及强大的信息学资源环境使这些特定目标在获奖期间可以实现。大多数 CKD 患者在初级保健机构接受护理。早期管理欠佳，这是一个重大的公共卫生问题。这项研究最重要的最终结果是概念证明，即“内置”实验室结果的风险预测模型可以促进适当的肾病转诊。目标 1 中以人为本的研究将为该项目提供一个用户友好的 HIT 工具，并将贡献有关初级保健 HIT 干预措施的文献。目标 2 的结果将有助于 R01 的初步数据，以肾科转诊作为主要结果。 K23 期间进行的研究将为后续的 R01 提供信息，该 R01 重点是改善门诊诊所 CKD 管理的其他方面，这是转化研究的一种形式。这些信息可能对改善 CKD 护理的未来研究有用，并且适用于其他肾脏疾病，包括其他全身性疾病、遗传性疾病或最初在初级保健机构进行监测和治疗的任何形式的 CKD。