Electronic Tools to Increase Recognition and Improve Primary Care Management for Hypertension in Chronic Kidney Disease

电子工具可提高对慢性肾病高血压的认识并改善初级保健管理

基本信息

批准号：
10689403
负责人：
Lipika Samal
金额：
$ 25.05万
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：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10689403
关键词：
Address Adopted Albumins Behavioral Blood Blood Pressure Cardiovascular Diseases Caring Chronic Chronic Kidney Failure Clinic Clinical Clinical Trials Computers Country Creatinine Cross-Over Studies Data Diagnosis Dialysis procedure Disease Management Disease Progression Effectiveness of Interventions Electronic Health Record End stage renal failure Grant Health Heart Human Hypertension Intention Intervention Kidney Diseases Kidney Failure Laboratories Length Measures Methods Outcome Patient Care Patients Persons Pharmaceutical Preparations Physicians Population Primary Care Physician Primary Health Care Process Measure Quality of life Questionnaires Randomized Randomized Controlled Trials Recommendation Registries Research Project Grants Risk Factors Running Serum Testing Urine Validation Work base behavior change behavioral economics blood pressure control cardiovascular risk factor clinical decision support computerized tools disease diagnosis effectiveness evaluation effectiveness testing evidence base hypertension control hypertension treatment improved innovation intervention effect mortality prevent primary care setting provider behavior secondary outcome symposium tool

项目摘要

The greatest opportunity to improve the length and quality of life for patients with chronic kidney disease (CKD) is to identify and intervene early on the chronic conditions that contribute to CKD progression and poor outcomes. Although both CKD and hypertension (HTN), the main risk factor for CKD progression, are not difficult to diagnose, both often go unrecognized by PCPs. Since patients with CKD generally receive their care from primary care physicians (PCPs), primary care-based interventions have the greatest potential to improve health for CKD patients. Electronic health records (EHRs) present an innovative delivery approach to improve CKD management in primary care. However, the impact of EHRs, registries and clinical decision support (CDS) has been modest in CKD. Hypothesis: The mean systolic blood pressure of the CKD population can be decreased by an intervention with three innovative features: 1) methods to synthesize EHR data in order to identify under-diagnosed chronic conditions, 2) iterative improvement in CDS content through human factors methods to maximize the “informativeness” of the CDS, and 3) the use of behavioral economic principles to create behavioral “nudges” internal and external to the CDS. Specific Aim 1: To develop and validate the intervention. Specific Aim 1a: To develop and validate the CDS that will: 1) synthesize existing laboratory tests, medication orders, and vital sign data; 2) increase recognition of CKD, 3) increase recognition of uncontrolled HTN in CKD patients; and 4) deliver evidence-based CKD and HTN management recommendations. The validation will consist of an 8-week silent run-in period and chart review. Specific Aim 1b: To improve the “informativeness” of the content of the CDS using human factors methods, specifically by conducting a “think-aloud” study. Specific Aim 1c: To develop a “wrap-around” intervention including three behavioral “nudges”: 1) pre-checked default orders, 2) an in-person conference with PCPs to obtain their commitment to follow the CDS recommendations, and 3) a required “accountable justification” if the PCP does not follow the CDS recommendations. Specific Aim 2: To test the effectiveness of the intervention. Specific Aim 2a: To evaluate whether the intervention developed in Aim 1 significantly decreases mean systolic blood pressure in a population of CKD patients with blood pressure > 140/90, N=2,350 (N derived from EHR data about primary care patients at 15 clinics). We will evaluate the effectiveness of the intervention in a pragmatic, cluster-randomized controlled trial, randomized at the level of the physician (180 PCPs). Secondary outcomes will include hypertension-specific process measures, such as treatment intensification. Specific Aim 2b: To evaluate whether the intervention improves process measures for quality of CKD care including: documented CKD diagnosis, annual serum creatinine test, and annual urine albumin test. Specific Aim 2c: To perform a cross-over study in order to evaluate the effect of the intervention on PCP behavior and PCPs' intention to change behavior, as measured by a validated 12-item questionnaire.

改善慢性肾脏疾病（CKD）患者生活质量和生活质量的最大机会是在有助于CKD进展和差的慢性条件下识别和干预结果。尽管CKD和高血压（HTN）是CKD进展的主要危险因素，但不是很难诊断，两者通常都无法被PCP识别。由于CKD患者通常会得到他们的护理从初级保健医生（PCP）中，基于初级保健的干预措施具有改进的最大潜力 CKD患者的健康。电子健康记录（EHRS）提出了一种创新的交付方法来改进 CKD管理中的初级保健。但是，EHR，注册表和临床决策支持的影响（CD）在CKD中是适中的。假设：CKD种群的平均收缩压可以是通过干预三个创新特征来减少：1）合成EHR数据的方法确定未诊断的慢性疾病，2）通过人为因素迭代CDS含量的迭代改善最大化CD的“信息性”的方法，以及3）使用行为经济原则创建在CD的内部和外部的行为“轻推”。特定目的1：开发和验证干涉。特定目的1A：开发和验证CD：1）合成现有实验室测试，药物订单和生命体征数据； 2）增加对CKD的识别，3）增加对 CKD患者的不受控制的HTN； 4）提供基于证据的CKD和HTN管理建议。验证将包括8周的无声磨合期和图表审查。具体目标 1B：使用人为因素方法提高CD含量的“信息性”，特别是进行“思考”研究。特定目标1C：开发“环绕式”干预措施，包括三个行为“轻推”：1）预先检查的默认订单，2）与PCP的面对面会议以获取其承诺遵循CDS建议，以及3）如果PCP确实如此不遵循CDS建议。特定目的2：测试干预的有效性。具体的 AIM 2A：评估AIM 1中开发的干预措施是否显着降低平均收缩血血压> 140/90，n = 2,350的CKD患者人群的压力（n来自EHR数据关于15个诊所的初级保健患者）。我们将评估务实的干预措施的有效性，聚类随机对照试验，在物理学水平（180个PCP）的水平上随机分组。次要结果将包括高血压特异性的过程度量，例如治疗强化。特定目标2b：评估干预措施是否改善了CKD护理质量的过程措施，包括： CKD诊断，年度血清肌酐测试和年度尿白蛋白测试。特定目标2C：执行跨界研究是为了评估干预对PCP行为和PCP的影响的影响通过经过验证的12项问卷来衡量的改变行为。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial.

DOI：
10.1136/bmjopen-2021-054065
发表时间：
2021-12-22
期刊：
BMJ open
影响因子：
2.9
作者：
Kilgallon JL;Gannon M;Burns Z;McMahon G;Dykes P;Linder J;Bates DW;Waikar S;Lipsitz S;Baer HJ;Samal L
通讯作者：
Samal L

Unpacking Contributors to CKD Incidence and Progression: Time to Move Beyond Traditional Risk Factors.

揭开 CKD 发病率和进展的影响因素：是时候超越传统风险因素了。

DOI：
10.1053/j.ajkd.2023.02.002
发表时间：
2023
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
0
作者：
Hansrivijit,Panupong;Samal,Lipika;Mendu,MallikaL
通讯作者：
Mendu,MallikaL

Human-centered design of clinical decision support for management of hypertension with chronic kidney disease.

DOI：
10.1186/s12911-022-01962-y
发表时间：
2022-08-13
期刊：
BMC MEDICAL INFORMATICS AND DECISION MAKING
影响因子：
3.5
作者：
Garabedian, Pamela M.;Gannon, Michael P.;Aaron, Skye;Wu, Edward;Burns, Zoe;Samal, Lipika
通讯作者：
Samal, Lipika

Health information technology to improve care for people with multiple chronic conditions.