Health Information Technology for Chronic Kidney Disease Management

慢性肾脏病管理的健康信息技术

• 批准号: 8911826
• 负责人: Lipika Samal
• 金额: $ 18.28万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8911826
• 关键词: Albumins; American; Award; Bicarbonates; Biometry; Boston; Calcium; Caring; Chronic; Chronic Kidney Failure; Clinic; Clinical; Clinical Trials; Cluster randomized trial; 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; 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; predictive modeling; prevent; primary care setting; primary outcome; response; routine care; satisfaction; secondary outcome; success; tool; usability; user-friendly

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的Brigham and妇女医院（BWH）的普通内科医生Lipika Samal博士的K23职业发展奖。萨马尔（Samal）博士正在建立自己的健康信息技术研究员（HIT），以改善慢性肾脏疾病（CKD）患者的结局。她的职业目标是成为一名独立资助的临床调查员。这项K23奖将帮助她实现以下目标：1）获得生物统计学，流行病学和HIT研究方法的高级培训，2）提高CKD管理的临床专业知识，3）3）在初级保健诊所开发和实施命中率，以改善CKD患者的监控，治疗和转诊，以确保临时仪式的状态，以确保竞选委员会的状态。为了实现这些目标，萨马尔博士选择了一个指导团队，致力于她作为临床调查员的成功。她的主要导师是BWH的普通内科医学主任戴维·贝茨（David Bates），也是一位国际知名的热门研究员。她的次要导师是肾脏科医生兼临床研究人员Sushrut Waikar博士，以及初级保健医生兼热门研究员Jeffrey Linder博士。她还将获得BWH肾部门负责人，美国肾脏科学会的前任主席Joseph Bonventre博士，以及初级保健医师兼CKD研究员Thomas Sequist博士，生物统计学家John Orav博士，约翰·奥拉夫（John Orav）博士，以及流行病学家弗朗西斯·库克（Francis Cook）博士。 CKD患者很大一部分在初级保健诊所接受了护理，因此在初级保健环境中的干预措施对于延迟进展到末期肾脏疾病（ESRD）很重要。 HIT系统可以促使对CKD的早期诊断，并可以根据向ESRD的进展风险帮助医生对患者进行分层。尽管如此，与其他慢性病相比，在CKD管理中利用命中率相对较少。我们建议在初级保健诊所开发和评估CKD管理的创新热门工具。我们的具体目标如下。具体目标1：根据Tangri等开发的风险预测模型，开发一个命中应用，以计算出向ESRD的风险。 Al。;特定目标1A：开发一种搜索方法，以找到现有的尿白蛋白与肌酐比率，血清钙，血清磷酸盐，血清白蛋白和血清碳酸氢盐值。通过手动图表审查验证搜索方法；特定目标1B：准备通过i）在收集PCP输入后设计用户界面，ii）进行可用性测试以及iii）召集跨学科窗格以确定我们医疗保健系统中转诊的风险阈值；具体目标2：进行集群随机试验，以确定命中应用对主要结果的影响：对风险预测模型的必要测试（尿白蛋白与肌酐比率，血清钙，血清磷酸血清，血清白蛋白和血清二甲苯酸血清）对主照明中的CKD患者。次要结果将包括肾脏科转介；血清肌酐加倍；血液透析的启动；和PCP满意度。 临床试验的注册和数据收集将依赖于常规护理期间收集的电子数据，这是一种低成本的，可行的研究方法。候选人的流行病学和信息学背景，指导和强大的信息学资源环境使这些特定的目标在奖励期内可以实现。 大多数CKD患者在初级保健环境中受到护理。早期管理是次优的，这代表了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，具有实验室结果“内置”的风险预测模型可以促进适当的肾脏科转介。 AIM 1中以人为中心的研究将有助于该项目的用户友好型命中工具，并将为初级保健命中干预措施做出贡献。 AIM 2的结果将有助于R01的初步数据，并将其作为主要结果。 在K23期间进行的研究将为随后的R01提供介绍，重点是改善Absuratory Clinics中CKD管理的其他方面，这是转化研究的一种形式。该信息可能对改善CKD护理的未来研究很有用，并且适用于其他肾脏疾病，包括其他系统性疾病，遗传性疾病或任何形式的CKD，其中最初在初级保健环境中进行监测和治疗。