Improving Care for Patients With Chronic Kidney Disease Using EMRALD

Study Overview
=================
Brief Summary
-----------------
This pragmatic cluster randomized controlled trial will test the impact of feedback and a toolkit aimed at improving the management of chronic kidney disease (CKD) in the primary care setting. This trial will use family physicians in Ontario participating in the Electronic.

Detailed Description
-----------------
This trial will use family physicians in Ontario participating in the Electronic Medical Record Administrative data Linked Database (EMRALD) and receiving the System for Audit and Feedback to Improve caRE (SAFIRE) along with other decision support tools. Performance on CKD quality indicators for family physicians receiving the CKD feedback and tools will be compared to physicians not receiving the CKD feedback or tools.

Official Title
-----------------
Improving Care for Patients With Chronic Kidney Disease Using Electronic Medical Record Interventions: A Pragmatic Cluster Randomized Trial

Conditions
-----------------
Chronic Kidney Disease

Intervention / Treatment
-----------------
* Behavioral: CKD feedback and tools


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Family physicians participating in EMRALD, on the EMR for >=2 years, roster size >=100 patients Patient criteria, rostered and actively seeing an EMRALD physician, on the EMR for .=1 year Exclusion Criteria: Updated data available at the time of study commencement
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: CKD feedback and tools<br>Physicians in these clinics/clusters will receive feedback on their performance for screening and managing CKD quality indicators as well as EMR tools to aid in their performance | Behavioral: CKD feedback and tools<br>* people in the intervention arm will receive feedback on ckd quality indicators and tools to help in the detection and management of ckd<br>|
| No Intervention: No Intervention<br>Physicians in these clinics/clusters will not receive CKD feedback or tools | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients age 50-80 with Stage 3+ CKD and a statin prescription | Comparison of proportion of patients age 50-80 years with Stage 3+ CKD (no dialysis or renal transplant) and receiving a statin prescription at baseline and at the end of the trial | 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients at high risk screened for CKD with an eGFR and/or ACR | compare baseline rates to end of intervention rates | 24 months | 
| Proportion of patients with an initial eGFR <60 and a f/u eGFR or an ACR | compare baseline rates to end of intervention rates | 24 months | 
| Proportion of patients with diabetes and albuminuria and on an ACE or ARB | compare baseline rates to end of intervention rates | 24 months | 
| Proportion of patients meeting eGFR criteria for CKD and documentation of CKD in the cumulative patient profile (CPP) | compare baseline rates to end of intervention rates | 24 months | 
| Proportion of patients with an ACR in the past 18 months and meeting bp targets | compare baseline rates to end of intervention rates | 24 months | 
| Proportion of patients age less than 80 years and an eGFR<30 being seen by or with a referral to a Nephrologist | compare baseline rates to end of intervention rates | 24 months |