Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language Summary
Rationale & Objective: To design and implement clinical decision support incorporating a validated risk prediction estimate of kidney failure in primary care clinics and to evaluate the impact on stage-appropriate monitoring and referral. Study Design: Block-randomized, pragmatic clinical tr...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-07-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059522001091 |
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| author | Lipika Samal John D. D’Amore Michael P. Gannon John L. Kilgallon Jean-Pierre Charles Devin M. Mann Lydia C. Siegel Kelly Burdge Shimon Shaykevich Stuart Lipsitz Sushrut S. Waikar David W. Bates Adam Wright |
| author_facet | Lipika Samal John D. D’Amore Michael P. Gannon John L. Kilgallon Jean-Pierre Charles Devin M. Mann Lydia C. Siegel Kelly Burdge Shimon Shaykevich Stuart Lipsitz Sushrut S. Waikar David W. Bates Adam Wright |
| author_sort | Lipika Samal |
| collection | DOAJ |
| description | Rationale & Objective: To design and implement clinical decision support incorporating a validated risk prediction estimate of kidney failure in primary care clinics and to evaluate the impact on stage-appropriate monitoring and referral. Study Design: Block-randomized, pragmatic clinical trial. Setting & Participants: Ten primary care clinics in the greater Boston area. Patients with stage 3-5 chronic kidney disease (CKD) were included. Patients were randomized within each primary care physician panel through a block randomization approach. The trial occurred between December 4, 2015, and December 3, 2016. Intervention: Point-of-care noninterruptive clinical decision support that delivered the 5-year kidney failure risk equation as well as recommendations for stage-appropriate monitoring and referral to nephrology. Outcomes: The primary outcome was as follows: Urine and serum laboratory monitoring test findings measured at one timepoint 6 months after the initial primary care visit and analyzed only in patients who had not undergone the recommended monitoring test in the preceding 12 months. The secondary outcome was nephrology referral in patients with a calculated kidney failure risk equation value of >10% measured at one timepoint 6 months after the initial primary care visit. Results: The clinical decision support application requested and processed 569,533 Continuity of Care Documents during the study period. Of these, 41,842 (7.3%) documents led to a diagnosis of stage 3, 4, or 5 CKD by the clinical decision support application. A total of 5,590 patients with stage 3, 4, or 5 CKD were randomized and included in the study. The link to the clinical decision support application was clicked 122 times by 57 primary care physicians. There was no association between the clinical decision support intervention and the primary outcome. There was a small but statistically significant difference in nephrology referral, with a higher rate of referral in the control arm. Limitations: Contamination within provider and clinic may have attenuated the impact of the intervention and may have biased the result toward null. Conclusions: The noninterruptive design of the clinical decision support was selected to prevent cognitive overload; however, the design led to a very low rate of use and ultimately did not improve stage-appropriate monitoring. Funding: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award K23DK097187. Trial Registration: ClinicalTrials.gov Identifier: NCT02990897. |
| first_indexed | 2024-04-13T03:43:13Z |
| format | Article |
| id | doaj.art-0eaa58b23b1241e7a2c2883927612dee |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-04-13T03:43:13Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-0eaa58b23b1241e7a2c2883927612dee2022-12-22T03:04:04ZengElsevierKidney Medicine2590-05952022-07-0147100493Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language SummaryLipika Samal0John D. D’Amore1Michael P. Gannon2John L. Kilgallon3Jean-Pierre Charles4Devin M. Mann5Lydia C. Siegel6Kelly Burdge7Shimon Shaykevich8Stuart Lipsitz9Sushrut S. Waikar10David W. Bates11Adam Wright12Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA; Address for Correspondence: Lipika Samal, MD, MPH, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont St, Boston, MA 02120.Informatics Department, Diameter Health, Farmington, CTDivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MADivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MADivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MANew York University School of Medicine, New York, NYDivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA; Mass General Brigham Digital Health eCare, Boston, MANephrology, Mass General Brigham-Salem Hospital, Salem, MADivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MADivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MANephrology, Mass General Brigham-Salem Hospital, Salem, MA; Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, MADivision of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MADepartment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TNRationale & Objective: To design and implement clinical decision support incorporating a validated risk prediction estimate of kidney failure in primary care clinics and to evaluate the impact on stage-appropriate monitoring and referral. Study Design: Block-randomized, pragmatic clinical trial. Setting & Participants: Ten primary care clinics in the greater Boston area. Patients with stage 3-5 chronic kidney disease (CKD) were included. Patients were randomized within each primary care physician panel through a block randomization approach. The trial occurred between December 4, 2015, and December 3, 2016. Intervention: Point-of-care noninterruptive clinical decision support that delivered the 5-year kidney failure risk equation as well as recommendations for stage-appropriate monitoring and referral to nephrology. Outcomes: The primary outcome was as follows: Urine and serum laboratory monitoring test findings measured at one timepoint 6 months after the initial primary care visit and analyzed only in patients who had not undergone the recommended monitoring test in the preceding 12 months. The secondary outcome was nephrology referral in patients with a calculated kidney failure risk equation value of >10% measured at one timepoint 6 months after the initial primary care visit. Results: The clinical decision support application requested and processed 569,533 Continuity of Care Documents during the study period. Of these, 41,842 (7.3%) documents led to a diagnosis of stage 3, 4, or 5 CKD by the clinical decision support application. A total of 5,590 patients with stage 3, 4, or 5 CKD were randomized and included in the study. The link to the clinical decision support application was clicked 122 times by 57 primary care physicians. There was no association between the clinical decision support intervention and the primary outcome. There was a small but statistically significant difference in nephrology referral, with a higher rate of referral in the control arm. Limitations: Contamination within provider and clinic may have attenuated the impact of the intervention and may have biased the result toward null. Conclusions: The noninterruptive design of the clinical decision support was selected to prevent cognitive overload; however, the design led to a very low rate of use and ultimately did not improve stage-appropriate monitoring. Funding: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award K23DK097187. Trial Registration: ClinicalTrials.gov Identifier: NCT02990897.http://www.sciencedirect.com/science/article/pii/S2590059522001091Chronic kidney disease (CKD)CKD awarenessCKD diagnosisCKD managementclinical decision support (CDS)electronic health record (EHR) |
| spellingShingle | Lipika Samal John D. D’Amore Michael P. Gannon John L. Kilgallon Jean-Pierre Charles Devin M. Mann Lydia C. Siegel Kelly Burdge Shimon Shaykevich Stuart Lipsitz Sushrut S. Waikar David W. Bates Adam Wright Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language Summary Kidney Medicine Chronic kidney disease (CKD) CKD awareness CKD diagnosis CKD management clinical decision support (CDS) electronic health record (EHR) |
| title | Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language Summary |
| title_full | Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language Summary |
| title_fullStr | Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language Summary |
| title_full_unstemmed | Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language Summary |
| title_short | Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical TrialPlain-Language Summary |
| title_sort | impact of kidney failure risk prediction clinical decision support on monitoring and referral in primary care management of ckd a randomized pragmatic clinical trialplain language summary |
| topic | Chronic kidney disease (CKD) CKD awareness CKD diagnosis CKD management clinical decision support (CDS) electronic health record (EHR) |
| url | http://www.sciencedirect.com/science/article/pii/S2590059522001091 |
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