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
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
248
automated clinical alerts in the electronic medical record
PCP education session on CKD
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
referral to a nephrologist
Referral to a nephrologist within the 12 months following decision support system activation.
Time frame: 12 months
Use of ACE/ARB
Active use of ACE/ARB at the end of the 12 month period following decision support system activation.
Time frame: 12 months
Annual ACR or PCR check
ACR or PCR within 12months of the decision support system activation
Time frame: 12 months
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