Impact of Dialysis Workflow Decision Support on Conformance to KDOQI Guidelines

透析工作流程决策支持对 KDOQI 指南一致性的影响

• 批准号: 7589119
• 负责人: John Hartman
• 金额: $ 86.44万
• 依托单位: VISONEX, LLC
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-11 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7589119
• 关键词: Acclimatization; Adherence; Administrator; Animal Welfare; Annual Reports; Bibliography; Blood; Calcium; Cardiovascular system; Caring; Chronic Kidney Failure; Clinic; Clinical; Clinical Data; Clinical Decision Support Systems; Clinical Nurse Specialists; Clinical Practice Guideline; Communication; Complex; Complication; Computer software; Computerized Medical Record; Computers; Country; Data; Data Analyses; Data Element; Data Set; Databases; Dialysis patients; Dialysis procedure; Disease Outcome; Drug usage; Electronic Mail; End stage renal failure; Ensure; Environment; Environmental Impact; Equipment; Evaluation; Expert Systems; Failure; Foundations; Future; Goals; Government; Guidelines; Health; Hour; Human Resources; IACUC; Individual; Information Systems; Information Technology; Institute of Medicine (U.S.); Instruction; International; Intervention; Kidney; Kidney Diseases; Lead; Link; Management Information Systems; Manuals; Marketing; Measures; Medical; Medical Care Team; Metabolism; Methods; Minerals; Names; Notification; Nurses; Online Systems; Parathyroid Hormones; Patient Care; Patients; Performance; Persons; Phase; Phosphorus; Physician Assistants; Physician Executives; Price; Principal Investigator; Provider; Public Health; Quality of Care; Recommendation; Relative Risks; Reporting; Research; Research Ethics Committees; Research Infrastructure; Resources; Role; Sales; Sensitivity and Specificity; Services; Simulate; Site; Solutions; Source; Specific qualifier value; Staging; System; Systems Analysis; Technology; Telefacsimile; Testing; Time; United States Centers for Medicare and Medicaid Services; Vertebrates; Work; abstracting; base; cardiovascular risk factor; commercial application; commercialization; compliance behavior; cost; evidence based guidelines; experience; expiration; falls; human PTH protein; human subject; improved; information gathering; innovation; insight; meetings; member; mortality; phrases; primary outcome; programs; quality assurance; response; software development; task analysis; tool; trend

DESCRIPTION (provided by applicant): KDOQI clinical practice guidelines (CPGs) improve dialysis patient care but their complexity makes them difficult to integrate into the dialysis clinic. Previous technological solutions {Electronic medical records, Clinical Decision Support Systems (CDS)} have failed because they were not integrated into the clinic workflow. Visonex LLC proposes to build and test (during Phases I and II) an innovative type of dialysis CDS that assists dialysis clinics to consistently conform to CPGs, provides workflow support and improves quality of care. In order to test the innovation, this project will focuses on a selected subset of KDOQI CPGs. Increased adherence to these CPGs is associated with decreased risk of cardiovascular and all-cause mortality. The software's workflow support will assist the clinic in responding faster and more accurately to CPG deviations and ensure completion of the tasks necessary to achieve conformance to CPG recommendations, improving the ability of the clinic to maintain mineral metabolism markers within their recommended ranges. The software will be built during Phase I and undergo functional testing. It will then be tested using de-identified retrospective data from dialysis clinics. The software's results will be compared to those of manual chart reviews of the same data by clinicians. Any differences between clinician and software will be examined and used to refine the software's functionality before phase II. In Phase II the software will be deployed and integrated into actual dialysis clinics in a stepwise manner. Further refinements will be made to increase the CDS's integration into clinic workflow based on information gathered during deployments. Phase II's overall aim is to increase the number of mineral metabolism markers maintained within the KDOQI recommended range for each patient. A supporting aim is to increase the number of CPG recommended tasks the clinic uses. All effects will be measured pre and post software deployment. The post deployment measures will occur after clinical acclimation to the CDS. While the study is not powered to look at mechanisms of improvement, a subset analysis will be performed with the intent of identifying trends, which could lead to future studies. The end of phase II will result in a dialysis CDS that is quickly assimilated into a clinic's workflow and assists in identifying and treating patients according to the recommendations of the CPGs, which are associated with improved health and decreased mortality. PUBLIC HEALTH RELEVANCE Chronic Kidney Disease (CKD) is a public health crisis and dialysis is the most expensive phase of CKD. The proposed project will result in an integrated expert system that assists dialysis clinics in consistently conforming to guidelines, improves control of mineral metabolism, and becomes a tool for improving the quality of care delivered to patients on dialysis. This system will enrich the data set being collected, providing a new and previously unobtainable insight into clinic operations that can be used for future research.

描述（由申请人提供）：KDOQI 临床实践指南 (CPG) 改善了透析患者护理，但其复杂性使其难以融入透析诊所。以前的技术解决方案{电子病历、临床决策支持系统（CDS）}都失败了，因为它们没有集成到诊所工作流程中。 Visonex LLC 提议构建并测试（在第一阶段和第二阶段）一种创新类型的透析 CDS，帮助透析诊所始终符合 CPG，提供工作流程支持并提高护理质量。 为了测试创新，该项目将重点关注 KDOQI CPG 的选定子集。增加对这些 CPG 的依从性与心血管和全因死亡率风险的降低相关。该软件的工作流程支持将帮助诊所更快、更准确地响应 CPG 偏差，并确保完成符合 CPG 建议所需的任务，从而提高诊所将矿物质代谢标记物维持在推荐范围内的能力。 该软件将在第一阶段构建并进行功能测试。然后将使用来自透析诊所的去识别化回顾性数据进行测试。该软件的结果将与临床医生对相同数据进行手动图表审查的结果进行比较。在第二阶段之前，临床医生和软件之间的任何差异都将被检查并用于完善软件的功能。 在第二阶段，该软件将逐步部署并集成到实际的透析诊所中。将根据部署期间收集的信息进行进一步改进，以增强 CDS 与诊所工作流程的集成。 II 期的总体目标是增加每位患者维持在 KDOQI 推荐范围内的矿物质代谢标志物的数量。支持目标是增加诊所使用的 CPG 推荐任务的数量。所有效果都将在软件部署前后进行测量。部署后措施将在 CDS 临床适应后进行。虽然该研究的目的不是为了研究改进机制，但将进行子集分析，目的是确定趋势，这可能会导致未来的研究。 第二阶段结束后，透析 CDS 将很快融入诊所的工作流程，并根据 CPG 的建议协助识别和治疗患者，这与改善健康状况和降低死亡率有关。 公共卫生相关性 慢性肾脏病 (CKD) 是一场公共卫生危机，透析是 CKD 最昂贵的阶段。拟议的项目将建立一个综合的专家系统，帮助透析诊所始终遵守指南，改善对矿物质代谢的控制，并成为提高透析患者护理质量的工具。该系统将丰富正在收集的数据集，为临床操作提供以前无法获得的新见解，可用于未来的研究。