Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study
Background: Risk prediction tools are used in a variety of clinical settings to guide patient care, although their use in chronic kidney disease (CKD) care is limited. Objectives: To assess the association of a risk-based model of CKD care on patient care, satisfaction, outcomes, and cost. Design: M...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2018-01-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/2054358117753618 |
| _version_ | 1811333481371795456 |
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| author | Brenda R. Hemmelgarn Michelle D. Smekal Robert G. Weaver Chandra Thomas Eleanor Benterud Kin Tam Braden J. Manns Marcello Tonelli Juli Finlay Maoliosa Donald Helen Tam-Tham Aminu Bello Navdeep Tangri Robert R. Quinn |
| author_facet | Brenda R. Hemmelgarn Michelle D. Smekal Robert G. Weaver Chandra Thomas Eleanor Benterud Kin Tam Braden J. Manns Marcello Tonelli Juli Finlay Maoliosa Donald Helen Tam-Tham Aminu Bello Navdeep Tangri Robert R. Quinn |
| author_sort | Brenda R. Hemmelgarn |
| collection | DOAJ |
| description | Background: Risk prediction tools are used in a variety of clinical settings to guide patient care, although their use in chronic kidney disease (CKD) care is limited. Objectives: To assess the association of a risk-based model of CKD care on patient care, satisfaction, outcomes, and cost. Design: Mixed-methods with a pre-post design. Setting: We will use mixed-methods and a pre-post design to evaluate use of the Kidney Failure Risk Equation (KFRE) to guide CKD care. The KFRE will be applied to patients currently followed in nephrology multidisciplinary CKD clinics in Alberta, as well as to new patients being considered for multidisciplinary care. Patients: Patients with a 2-year risk of kidney failure ≥10% or estimated glomerular filtration rate (eGFR) ≤15 mL/min/1.73 m 2 will be recommended care by a multidisciplinary team coordinated by a nurse clinician and nephrologist, with access to other multidisciplinary resources including dietitians, pharmacists, and social workers as required. Measurements/Methods: Focus groups and interviews will be conducted to qualitatively describe patient and provider perspectives of potential barriers and facilitators to implementation of the risk-based approach to CKD care. Patient and provider surveys will also be used to quantify patient and provider satisfaction before and after the intervention. Finally, administrative data will be used to evaluate the association between the risk-based approach to care and outcomes including health care resource use, frequency of testing, modality choice, and death. Conclusions: Use of a risk-based model of care has the potential to increase use of optimal treatments such as the use of home dialysis and preemptive kidney transplantation, while reducing costs and poor outcomes related to processes of care such as unnecessary laboratory testing; however, there is also potential for unintended consequences. Our mixed-methods approach will integrate perceptions and needs from key stakeholders (including patients with CKD, their families, and their providers) to guide implementation and ensure appropriate modifications. |
| first_indexed | 2024-04-13T16:53:27Z |
| format | Article |
| id | doaj.art-df98e0b851fa4feebef1f0f08867a2d5 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-04-13T16:53:27Z |
| publishDate | 2018-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-df98e0b851fa4feebef1f0f08867a2d52022-12-22T02:38:53ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812018-01-01510.1177/2054358117753618Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods StudyBrenda R. Hemmelgarn0Michelle D. Smekal1Robert G. Weaver2Chandra Thomas3Eleanor Benterud4Kin Tam5Braden J. Manns6Marcello Tonelli7Juli Finlay8Maoliosa Donald9Helen Tam-Tham10Aminu Bello11Navdeep Tangri12Robert R. Quinn13Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaInterdisciplinary Chronic Disease Collaboration, Calgary, Alberta, CanadaInterdisciplinary Chronic Disease Collaboration, Calgary, Alberta, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaDepartment of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, CanadaDepartment of Medicine, University of Alberta, Edmonton, Alberta, CanadaChronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, CanadaDepartment of Medicine, Cumming School of Medicine, University of Calgary, Alberta, CanadaBackground: Risk prediction tools are used in a variety of clinical settings to guide patient care, although their use in chronic kidney disease (CKD) care is limited. Objectives: To assess the association of a risk-based model of CKD care on patient care, satisfaction, outcomes, and cost. Design: Mixed-methods with a pre-post design. Setting: We will use mixed-methods and a pre-post design to evaluate use of the Kidney Failure Risk Equation (KFRE) to guide CKD care. The KFRE will be applied to patients currently followed in nephrology multidisciplinary CKD clinics in Alberta, as well as to new patients being considered for multidisciplinary care. Patients: Patients with a 2-year risk of kidney failure ≥10% or estimated glomerular filtration rate (eGFR) ≤15 mL/min/1.73 m 2 will be recommended care by a multidisciplinary team coordinated by a nurse clinician and nephrologist, with access to other multidisciplinary resources including dietitians, pharmacists, and social workers as required. Measurements/Methods: Focus groups and interviews will be conducted to qualitatively describe patient and provider perspectives of potential barriers and facilitators to implementation of the risk-based approach to CKD care. Patient and provider surveys will also be used to quantify patient and provider satisfaction before and after the intervention. Finally, administrative data will be used to evaluate the association between the risk-based approach to care and outcomes including health care resource use, frequency of testing, modality choice, and death. Conclusions: Use of a risk-based model of care has the potential to increase use of optimal treatments such as the use of home dialysis and preemptive kidney transplantation, while reducing costs and poor outcomes related to processes of care such as unnecessary laboratory testing; however, there is also potential for unintended consequences. Our mixed-methods approach will integrate perceptions and needs from key stakeholders (including patients with CKD, their families, and their providers) to guide implementation and ensure appropriate modifications.https://doi.org/10.1177/2054358117753618 |
| spellingShingle | Brenda R. Hemmelgarn Michelle D. Smekal Robert G. Weaver Chandra Thomas Eleanor Benterud Kin Tam Braden J. Manns Marcello Tonelli Juli Finlay Maoliosa Donald Helen Tam-Tham Aminu Bello Navdeep Tangri Robert R. Quinn Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study Canadian Journal of Kidney Health and Disease |
| title | Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study |
| title_full | Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study |
| title_fullStr | Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study |
| title_full_unstemmed | Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study |
| title_short | Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study |
| title_sort | implementation and evaluation of a risk based approach to guide chronic kidney disease care protocol for a multiphase mixed methods study |
| url | https://doi.org/10.1177/2054358117753618 |
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