Automated Clinical Reminders for Primary Care Providers in the Care of CKD: A Small Cluster-Randomized Controlled Trial
Background Primary care physicians (PCPs) care for most non–dialysis-dependent patients with chronic kidney disease (CKD). Studies suggest that PCPs may deliver suboptimal CKD care. One means to improve PCP treatment of CKD is clinical decision support systems (CDSSs). Study Design Cluster-randomize...
Gespeichert in:
| Veröffentlicht in: | American journal of kidney diseases 2011-12, Vol.58 (6), p.894-902 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 902 |
|---|---|
| container_issue | 6 |
| container_start_page | 894 |
| container_title | American journal of kidney diseases |
| container_volume | 58 |
| creator | Abdel-Kader, Khaled, MD, MSc Fischer, Gary S., MD Li, Jie, MA Moore, Charity G., PhD Hess, Rachel, MD, MSc Unruh, Mark L., MD, MSc |
| description | Background Primary care physicians (PCPs) care for most non–dialysis-dependent patients with chronic kidney disease (CKD). Studies suggest that PCPs may deliver suboptimal CKD care. One means to improve PCP treatment of CKD is clinical decision support systems (CDSSs). Study Design Cluster-randomized controlled trial. Setting & Participants 30 PCPs in a university-based outpatient general internal medicine practice and their 248 patients with moderate to advanced CKD who had not been referred to a nephrologist. Intervention 2 CKD educational sessions were held for PCPs in both arms. The 15 intervention-arm PCPs also received real-time automated electronic medical record alerts for patients with estimated glomerular filtration rates |
| doi_str_mv | 10.1053/j.ajkd.2011.08.028 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3221894</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0272638611013138</els_id><sourcerecordid>905679866</sourcerecordid><originalsourceid>FETCH-LOGICAL-c539t-f1dc032d09a5a426ca588be4efc1abc4dac1a7ea8aa8944fe010b2cea6e8eec3</originalsourceid><addsrcrecordid>eNp9kk1v1DAQhiMEokvhD3BAuSBOCf5IvA5ClVahfIhKoHbv1qwzoU6duLWTRe2vxyFL-ThwGtvzzuuxn0mS55TklJT8dZdDd9XkjFCaE5kTJh8kK1oyngnJ5cNkRdiaZYJLcZQ8CaEjhFRciMfJEaOVZEUpVsn3zTS6HkZs0tqawWiw6Tn2ZmjQh7R1Pv3qTQ_-Nq3BY9y4vfmZMkM6XuJy6tq0_vzuTbpJL3qwNjpNYUSfncPQuN7czeZuGL2zNi633oB9mjxqwQZ8dojHyfb96bb-mJ19-fCp3pxluuTVmLW00YSzhlRQQsGEhlLKHRbYago7XTQQ4xpBAsiqKFoklOyYRhAoETU_Tk4W2-tp12OjMXYBVl0vb1IOjPo7M5hL9c3tFWeMRsdo8Opg4N3NhGFUvQkarYUB3RRURUqxrqQQUckWpfYuBI_t_S2UqJmX6tTMS828FJEq8opFL_7s777kF6AoeHkQQIhsWg-DNuG3rmRlpDzr3i46jJ-5N-hV0AYHjY3xqEfVOPP_Pk7-KdeHabjCWwydm_wQMSmqAlNEXcyTNQ8WpYRyyiX_AcxRy4s</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>905679866</pqid></control><display><type>article</type><title>Automated Clinical Reminders for Primary Care Providers in the Care of CKD: A Small Cluster-Randomized Controlled Trial</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Abdel-Kader, Khaled, MD, MSc ; Fischer, Gary S., MD ; Li, Jie, MA ; Moore, Charity G., PhD ; Hess, Rachel, MD, MSc ; Unruh, Mark L., MD, MSc</creator><creatorcontrib>Abdel-Kader, Khaled, MD, MSc ; Fischer, Gary S., MD ; Li, Jie, MA ; Moore, Charity G., PhD ; Hess, Rachel, MD, MSc ; Unruh, Mark L., MD, MSc</creatorcontrib><description>Background Primary care physicians (PCPs) care for most non–dialysis-dependent patients with chronic kidney disease (CKD). Studies suggest that PCPs may deliver suboptimal CKD care. One means to improve PCP treatment of CKD is clinical decision support systems (CDSSs). Study Design Cluster-randomized controlled trial. Setting & Participants 30 PCPs in a university-based outpatient general internal medicine practice and their 248 patients with moderate to advanced CKD who had not been referred to a nephrologist. Intervention 2 CKD educational sessions were held for PCPs in both arms. The 15 intervention-arm PCPs also received real-time automated electronic medical record alerts for patients with estimated glomerular filtration rates <45 mL/min/1.73 m2 recommending renal referral and urine albumin quantification if not done within the prior year. Outcomes Primary outcome was referral to a nephrologist; secondary outcomes were albuminuria/proteinuria assessment, CKD documentation, optimal blood pressure (ie, <130/80 mm Hg), and use of renoprotective medications. Results The intervention and control arms did not differ in renal referrals (9.7% vs 16.5%, respectively; between-group difference, −6.8%; 95% CI, −15.5% to 1.8%; P = 0.1) or proteinuria assessments (39.3% vs 30.1%, respectively; between-group difference, 9.2%; 95% CI, −2.7% to 21.1%; P = 0.1). For intervention and control patients without a baseline proteinuria assessment, 27.7% versus 16.3%, respectively, had one at follow-up ( P = 0.06). After controlling for clustering, these findings were largely unchanged and no significant differences were apparent between groups. Limitations Small single-center university-based practice, use of a passive CDSS that required PCPs to trigger the electronic order set. Conclusions PCPs were willing to partake in a randomized trial of a CDSS to improve outpatient CKD care. Although CDSSs may have potential, larger studies are needed to further explore how best to deploy them to enhance CKD care.</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2011.08.028</identifier><identifier>PMID: 21982456</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Chronic kidney disease ; Decision Support Systems, Clinical ; estimated glomerular filtration rate ; Feasibility Studies ; Female ; Glomerular Filtration Rate ; Humans ; Kidneys ; Male ; Medical sciences ; Middle Aged ; nephrologist ; Nephrology ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Physicians, Primary Care ; Practice Patterns, Physicians' - standards ; primary care physician ; quality of care ; Quality of Health Care - standards ; Reminder Systems ; Renal failure ; Renal Insufficiency, Chronic - physiopathology ; Renal Insufficiency, Chronic - therapy ; renal referral ; Urinary system involvement in other diseases. Miscellaneous</subject><ispartof>American journal of kidney diseases, 2011-12, Vol.58 (6), p.894-902</ispartof><rights>National Kidney Foundation, Inc.</rights><rights>2011 National Kidney Foundation, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</rights><rights>2011 The National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c539t-f1dc032d09a5a426ca588be4efc1abc4dac1a7ea8aa8944fe010b2cea6e8eec3</citedby><cites>FETCH-LOGICAL-c539t-f1dc032d09a5a426ca588be4efc1abc4dac1a7ea8aa8944fe010b2cea6e8eec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0272638611013138$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25250276$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21982456$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abdel-Kader, Khaled, MD, MSc</creatorcontrib><creatorcontrib>Fischer, Gary S., MD</creatorcontrib><creatorcontrib>Li, Jie, MA</creatorcontrib><creatorcontrib>Moore, Charity G., PhD</creatorcontrib><creatorcontrib>Hess, Rachel, MD, MSc</creatorcontrib><creatorcontrib>Unruh, Mark L., MD, MSc</creatorcontrib><title>Automated Clinical Reminders for Primary Care Providers in the Care of CKD: A Small Cluster-Randomized Controlled Trial</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>Background Primary care physicians (PCPs) care for most non–dialysis-dependent patients with chronic kidney disease (CKD). Studies suggest that PCPs may deliver suboptimal CKD care. One means to improve PCP treatment of CKD is clinical decision support systems (CDSSs). Study Design Cluster-randomized controlled trial. Setting & Participants 30 PCPs in a university-based outpatient general internal medicine practice and their 248 patients with moderate to advanced CKD who had not been referred to a nephrologist. Intervention 2 CKD educational sessions were held for PCPs in both arms. The 15 intervention-arm PCPs also received real-time automated electronic medical record alerts for patients with estimated glomerular filtration rates <45 mL/min/1.73 m2 recommending renal referral and urine albumin quantification if not done within the prior year. Outcomes Primary outcome was referral to a nephrologist; secondary outcomes were albuminuria/proteinuria assessment, CKD documentation, optimal blood pressure (ie, <130/80 mm Hg), and use of renoprotective medications. Results The intervention and control arms did not differ in renal referrals (9.7% vs 16.5%, respectively; between-group difference, −6.8%; 95% CI, −15.5% to 1.8%; P = 0.1) or proteinuria assessments (39.3% vs 30.1%, respectively; between-group difference, 9.2%; 95% CI, −2.7% to 21.1%; P = 0.1). For intervention and control patients without a baseline proteinuria assessment, 27.7% versus 16.3%, respectively, had one at follow-up ( P = 0.06). After controlling for clustering, these findings were largely unchanged and no significant differences were apparent between groups. Limitations Small single-center university-based practice, use of a passive CDSS that required PCPs to trigger the electronic order set. Conclusions PCPs were willing to partake in a randomized trial of a CDSS to improve outpatient CKD care. Although CDSSs may have potential, larger studies are needed to further explore how best to deploy them to enhance CKD care.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Chronic kidney disease</subject><subject>Decision Support Systems, Clinical</subject><subject>estimated glomerular filtration rate</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>nephrologist</subject><subject>Nephrology</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Physicians, Primary Care</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>primary care physician</subject><subject>quality of care</subject><subject>Quality of Health Care - standards</subject><subject>Reminder Systems</subject><subject>Renal failure</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Renal Insufficiency, Chronic - therapy</subject><subject>renal referral</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk1v1DAQhiMEokvhD3BAuSBOCf5IvA5ClVahfIhKoHbv1qwzoU6duLWTRe2vxyFL-ThwGtvzzuuxn0mS55TklJT8dZdDd9XkjFCaE5kTJh8kK1oyngnJ5cNkRdiaZYJLcZQ8CaEjhFRciMfJEaOVZEUpVsn3zTS6HkZs0tqawWiw6Tn2ZmjQh7R1Pv3qTQ_-Nq3BY9y4vfmZMkM6XuJy6tq0_vzuTbpJL3qwNjpNYUSfncPQuN7czeZuGL2zNi633oB9mjxqwQZ8dojHyfb96bb-mJ19-fCp3pxluuTVmLW00YSzhlRQQsGEhlLKHRbYago7XTQQ4xpBAsiqKFoklOyYRhAoETU_Tk4W2-tp12OjMXYBVl0vb1IOjPo7M5hL9c3tFWeMRsdo8Opg4N3NhGFUvQkarYUB3RRURUqxrqQQUckWpfYuBI_t_S2UqJmX6tTMS828FJEq8opFL_7s777kF6AoeHkQQIhsWg-DNuG3rmRlpDzr3i46jJ-5N-hV0AYHjY3xqEfVOPP_Pk7-KdeHabjCWwydm_wQMSmqAlNEXcyTNQ8WpYRyyiX_AcxRy4s</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Abdel-Kader, Khaled, MD, MSc</creator><creator>Fischer, Gary S., MD</creator><creator>Li, Jie, MA</creator><creator>Moore, Charity G., PhD</creator><creator>Hess, Rachel, MD, MSc</creator><creator>Unruh, Mark L., MD, MSc</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20111201</creationdate><title>Automated Clinical Reminders for Primary Care Providers in the Care of CKD: A Small Cluster-Randomized Controlled Trial</title><author>Abdel-Kader, Khaled, MD, MSc ; Fischer, Gary S., MD ; Li, Jie, MA ; Moore, Charity G., PhD ; Hess, Rachel, MD, MSc ; Unruh, Mark L., MD, MSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c539t-f1dc032d09a5a426ca588be4efc1abc4dac1a7ea8aa8944fe010b2cea6e8eec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Chronic kidney disease</topic><topic>Decision Support Systems, Clinical</topic><topic>estimated glomerular filtration rate</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>nephrologist</topic><topic>Nephrology</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Physicians, Primary Care</topic><topic>Practice Patterns, Physicians' - standards</topic><topic>primary care physician</topic><topic>quality of care</topic><topic>Quality of Health Care - standards</topic><topic>Reminder Systems</topic><topic>Renal failure</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Renal Insufficiency, Chronic - therapy</topic><topic>renal referral</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abdel-Kader, Khaled, MD, MSc</creatorcontrib><creatorcontrib>Fischer, Gary S., MD</creatorcontrib><creatorcontrib>Li, Jie, MA</creatorcontrib><creatorcontrib>Moore, Charity G., PhD</creatorcontrib><creatorcontrib>Hess, Rachel, MD, MSc</creatorcontrib><creatorcontrib>Unruh, Mark L., MD, MSc</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abdel-Kader, Khaled, MD, MSc</au><au>Fischer, Gary S., MD</au><au>Li, Jie, MA</au><au>Moore, Charity G., PhD</au><au>Hess, Rachel, MD, MSc</au><au>Unruh, Mark L., MD, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Automated Clinical Reminders for Primary Care Providers in the Care of CKD: A Small Cluster-Randomized Controlled Trial</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>58</volume><issue>6</issue><spage>894</spage><epage>902</epage><pages>894-902</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>Background Primary care physicians (PCPs) care for most non–dialysis-dependent patients with chronic kidney disease (CKD). Studies suggest that PCPs may deliver suboptimal CKD care. One means to improve PCP treatment of CKD is clinical decision support systems (CDSSs). Study Design Cluster-randomized controlled trial. Setting & Participants 30 PCPs in a university-based outpatient general internal medicine practice and their 248 patients with moderate to advanced CKD who had not been referred to a nephrologist. Intervention 2 CKD educational sessions were held for PCPs in both arms. The 15 intervention-arm PCPs also received real-time automated electronic medical record alerts for patients with estimated glomerular filtration rates <45 mL/min/1.73 m2 recommending renal referral and urine albumin quantification if not done within the prior year. Outcomes Primary outcome was referral to a nephrologist; secondary outcomes were albuminuria/proteinuria assessment, CKD documentation, optimal blood pressure (ie, <130/80 mm Hg), and use of renoprotective medications. Results The intervention and control arms did not differ in renal referrals (9.7% vs 16.5%, respectively; between-group difference, −6.8%; 95% CI, −15.5% to 1.8%; P = 0.1) or proteinuria assessments (39.3% vs 30.1%, respectively; between-group difference, 9.2%; 95% CI, −2.7% to 21.1%; P = 0.1). For intervention and control patients without a baseline proteinuria assessment, 27.7% versus 16.3%, respectively, had one at follow-up ( P = 0.06). After controlling for clustering, these findings were largely unchanged and no significant differences were apparent between groups. Limitations Small single-center university-based practice, use of a passive CDSS that required PCPs to trigger the electronic order set. Conclusions PCPs were willing to partake in a randomized trial of a CDSS to improve outpatient CKD care. Although CDSSs may have potential, larger studies are needed to further explore how best to deploy them to enhance CKD care.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21982456</pmid><doi>10.1053/j.ajkd.2011.08.028</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0272-6386 |
| ispartof | American journal of kidney diseases, 2011-12, Vol.58 (6), p.894-902 |
| issn | 0272-6386 1523-6838 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3221894 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Biological and medical sciences Chronic kidney disease Decision Support Systems, Clinical estimated glomerular filtration rate Feasibility Studies Female Glomerular Filtration Rate Humans Kidneys Male Medical sciences Middle Aged nephrologist Nephrology Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Physicians, Primary Care Practice Patterns, Physicians' - standards primary care physician quality of care Quality of Health Care - standards Reminder Systems Renal failure Renal Insufficiency, Chronic - physiopathology Renal Insufficiency, Chronic - therapy renal referral Urinary system involvement in other diseases. Miscellaneous |
| title | Automated Clinical Reminders for Primary Care Providers in the Care of CKD: A Small Cluster-Randomized Controlled Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T21%3A13%3A07IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Automated%20Clinical%20Reminders%20for%20Primary%20Care%20Providers%20in%20the%20Care%20of%20CKD:%20A%20Small%20Cluster-Randomized%20Controlled%20Trial&rft.jtitle=American%20journal%20of%20kidney%20diseases&rft.au=Abdel-Kader,%20Khaled,%20MD,%20MSc&rft.date=2011-12-01&rft.volume=58&rft.issue=6&rft.spage=894&rft.epage=902&rft.pages=894-902&rft.issn=0272-6386&rft.eissn=1523-6838&rft_id=info:doi/10.1053/j.ajkd.2011.08.028&rft_dat=%3Cproquest_pubme%3E905679866%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=905679866&rft_id=info:pmid/21982456&rft_els_id=1_s2_0_S0272638611013138&rfr_iscdi=true |