Chronic Kidney Disease (CKD) Guideline Adherence - A Quality Improvement Study

Study Overview
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Brief Summary
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Chronic kidney disease (CKD) is defined as kidney damage for greater than 3 months or a glomerular filtration rate less than 60 mL/min per 1.73m2 for greater than 3 months. Patients with CKD are at high risk for development of cardiovascular disease and metabolic complications. Guidelines for the care of patients with CKD have been developed by the National Kidney Foundation. Despite the wide availability of these guidelines, adherence is low. The goal of the current study is to evaluate whether a multifactorial intervention, including a CKD registry, will improve CKD guideline adherence. The hypothesis is that providers exposed to a multifactorial clinical intervention including education, academic detailing, and a CKD registry will be more likely to adhere to CKD guidelines than those only exposed to education.

Official Title
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Chronic Kidney Disease Guideline Adherence - a Cluster Randomized Controlled Quality Improvement Study

Conditions
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Chronic Renal Insufficiency

Intervention / Treatment
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* Behavioral: Education only
* Behavioral: Multifactorial intervention


Participation Criteria
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Eligibility Criteria
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Providers: Inclusion Criteria: All primary care providers at the Wade Park Veterans Affairs Medical Center (VAMC) will be eligible for the study Patients: Inclusion Criteria: Receive primary care from a provider at the Wade Park VAMC Have: CKD as defined by an estimated glomerular filtration rate (eGFR) less than 60 on two separate occasions 90 to 730 days apart, diabetes, OR hypertension Exclusion Criteria: End-stage renal disease Renal transplant recipients Less than 18 years of age on July 1, 2009 No primary care visit between Jan 1, 2008 and July 1, 2009

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 |
| --- | --- |
| Experimental: Multifactorial intervention<br>The multifactorial intervention will consist of a CKD lecture, the CKD reference card, academic detailing, and access to the CKD registry. | Behavioral: Multifactorial intervention<br>* Providers in the intervention group will receive a lecture on CKD, a CKD reference card, academic detailing (residents only), and access to the CKD registry.<br>|
| Active Comparator: Education only<br>Providers in the education only arm will receive a CKD lecture and be given a CKD reference card. | Behavioral: Education only<br>* The education will consist of a lecture and distribution of a CKD reference card.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PTH (Parathyroid Hormone) Adherence | Probability for having a PTH measured during the study period comparing intervention vs control clinic during the study period as estimated by Generalized Estimating Equation (determines probability, not proportion). Participants assigned 1 if PTH was measured and 0 if PTH was not measured during the study period. | One year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Last Clinic BP <130/80 mmHg | Probability of last Clinic BP <130/80 mmHg Comparing Intervention vs Control Clinic During the Study Period as estimated using Generalized Estimating Equation. | One year |