Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

Study Overview
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Brief Summary
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To determine whether the use of educational sessions and computerized clinical reminders can improve primary care doctors' delivery of care to CKD patients compared to educational sessions alone. Hypothesis: Clinical reminders will improve the care delivered to CKD patients

Detailed Description
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Literature supports that most chronic kidney disease (CKD) patients are cared for by primary care physicians (PCP) without the help of a kidney specialist. Many of these patients fail to achieve targeted outcomes and late referral to a nephrologist has been associated with an increased risk of death. Automated computerized clinical reminders have been shown to improve physician compliance with recommended guidelines in other settings. Aims: To determine if clinical reminders can help PCPs decrease the rate of late referrals, improve urine albumin checks in CKD patients Design: prospective randomized controlled, single-blinded study with additional historical control Methods: Two 20-minute teaching sessions aimed at all GIM PCPs in the UPMC clinic followed by randomization of the eligible GIM providers to receive automated clinical reminders (CR) for their CKD stage 3b-5 patients versus routine care. Outcomes: Using a database search, individuals with an eGFR<45ml/min/1.73m2 (not seen by a nephrologist) will have data collected on: PCP referral to a nephrologist, urinary albumin (or protein) quantification in the past year, PCP recognition of patients with eGFR<45ml/min, ACE/ARB usage.

Official Title
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Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

Conditions
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Chronic Kidney Disease

Intervention / Treatment
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* Other: automated clinical alerts
* Other: provider education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For PCPs: all GIM attending physicians with a weekly continuity clinic. For patients: >= 18 years-old with an eGFR<45ml/min/1.73m2 being seen in the UPMC GIM clinic by a faculty member during the 10-month intervention period Exclusion Criteria: for PCPs: imminent plans to leave the department patients with a renal transplant, on any form of dialysis, or with a previous nephrology evaluation.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1<br>education and automated clinical alerts | Other: automated clinical alerts<br>* automated clinical alerts in the electronic medical record<br>Other: provider education<br>* PCP education session on CKD<br>|
| Active Comparator: 2<br>education session alone | Other: provider education<br>* PCP education session on CKD<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| referral to a nephrologist | Referral to a nephrologist within the 12 months following decision support system activation. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of ACE/ARB | Active use of ACE/ARB at the end of the 12 month period following decision support system activation. | 12 months | 
| Annual ACR or PCR check | ACR or PCR within 12months of the decision support system activation | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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chronic kidney disease, clinical alerts, late referral, electronic medical record, Computerized clinical decision support systems (CDSS)