Clinical trial NCT00688285: Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients
Official title: Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Chronic Kidney Disease
Keywords: chronic kidney disease
clinical alerts
late referral
electronic medical record
Computerized clinical decision support systems (CDSS)
Lead sponsor: University of Pittsburgh
Sponsor class: OTHER
First posted: 2008-06-02
Enrollment: 248
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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.

Primary outcomes:
measure: referral to a nephrologist
timeFrame: 12 months
Secondary outcomes:
measure: Use of ACE/ARB
timeFrame: 12 months
measure: Annual ACR or PCR check
timeFrame: 12 months
Other outcomes:
Locations:
city: Pittsburgh
country: United States
facility: University of Pittsburgh
state: Pennsylvania
Study officials:
affiliation: University of Pittsburgh
name: Khaled Abdel-Kader, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Pittsburgh
name: Mark Unruh, MD, MSc
role: PRINCIPAL_INVESTIGATOR
References:
citation: Abdel-Kader K, Fischer GS, Li J, Moore CG, Hess R, Unruh ML. Automated clinical reminders for primary care providers in the care of CKD: a small cluster-randomized controlled trial. Am J Kidney Dis. 2011 Dec;58(6):894-902. doi: 10.1053/j.ajkd.2011.08.028. Epub 2011 Oct 7.