Electronic health record based population health management to optimize care in CKD: Design of the Kidney Coordinated HeAlth Management Partnership (K-CHAMP) trial

Jhamb, Manisha; Weltman, Melanie R.; Yabes, Jonathan G.; Kamat, Sunil; Devaraj, Susan M.; Fischer, Gary S.; Rollman, Bruce L.; Nolin, Thomas D.; Abdel-Kader, Khaled

doi:10.1016/j.cct.2023.107269

Cited by 5 publications

(5 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[34][35][36][37] A recent publication described the protocol for the Kidney Coordinated HeAlth Management Partnership trial which will test the effectiveness of proactive e-consults sent from nephrologists and clinical pharmacists to PCPs for primary care patients with CKD. 38 Preliminary data from our study and others suggest that this strategy can be scaled to implement other highimpact guidelines at institutional and national levels to close practice and care gaps. 18 21 We found that PCPs and specialists valued multidisciplinary collaboration; however, some PCPs felt that MPE felt more prescriptive than collaborative.…”

Section: Discussionmentioning

confidence: 81%

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study

Rikin,

Bauman,

Arnaoudova

et al. 2024

BMJ Open Diab Res Care

View full text Add to dashboard Cite

IntroductionWe hypothesized that multidisciplinary, proactive electronic consultation (MPE) could overcome barriers to prescribing guideline-directed medical therapies (GDMTs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).Research design and methodsWe conducted an efficacy-implementation pilot study of MPE for T2D and CKD for primary care provider (PCP)–patient dyads at an academic health system. MPE included (1) a dashboard to identify patients without a prescription for sodium-glucose cotransporter-2 inhibitors (SGLT2i) and without a maximum dose prescription for renin–angiotensin–aldosterone system inhibitors (RAASi), (2) a multidisciplinary team of specialists to provide recommendations using e-consult templates, and (3) a workflow to deliver timely e-consult recommendations to PCPs. In-depth interviews were conducted with PCPs and specialists to assess feasibility, acceptability, and appropriateness of MPE and were analyzed using an iterative qualitative analysis approach to identify major themes. Prescription data were extracted from the electronic health record to assess preliminary effectiveness to increase GDMT.Results20 PCPs agreed to participate, 18 PCPs received MPEs for one of their patients with T2D and CKD, and 16 PCPs and 2 specialists were interviewed. Major themes were as follows: appropriateness of prioritization of GDMT for T2D and CKD, acceptability of the content of the recommendations, PCP characteristics impact experience with MPE, acceptability and appropriateness of multidisciplinary collaboration, feasibility of MPE to overcome patient-specific barriers to GDMT, and appropriateness of workflow. At 6 months postbaseline, 7/18 (39%) patients were newly prescribed an SGLT2i, and 7/18 (39%) patients were either newly prescribed or had increased dose of RAASi.ConclusionsMPE was an acceptable and appropriate health system strategy to identify and address gaps in GDMT among patients with T2D and CKD. Adopting MPE could enhance GDMT, though PCPs raised feasibility concerns which could be improved with program enhancements, including follow-up e-consults for reinforcement, and administrative support for navigating system-level barriers.

show abstract

Section: Discussionmentioning

confidence: 81%

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study

Rikin,

Bauman,

Arnaoudova

et al. 2024

BMJ Open Diab Res Care

View full text Add to dashboard Cite

show abstract

“…16 Another study of an EHR-based population health management system focused on slowing progression of CKD has finished enrollment, and results are pending. 42,43 Previous studies have reported that an antihypertensive-focused CDS system for patients with CKD was successful in increasing UACR testing 17,20,21 and nephrology referral. 21 We believe that our study is the first to show a significant positive effect on SBP as a continuous outcome.…”

Section: Discussionmentioning

confidence: 99%

“…One study found that a CKD CDS system successfully slowed annualized loss of eGFR . Another study of an EHR-based population health management system focused on slowing progression of CKD has finished enrollment, and results are pending . Previous studies have reported that an antihypertensive-focused CDS system for patients with CKD was successful in increasing UACR testing and nephrology referral .…”

Section: Discussionmentioning

confidence: 99%

Clinical Decision Support for Hypertension Management in Chronic Kidney Disease

Samal,

Kilgallon,

Lipsitz

et al. 2024

JAMA Intern Med

View full text Add to dashboard Cite

ImportanceChronic kidney disease (CKD) affects 37 million adults in the United States, and for patients with CKD, hypertension is a key risk factor for adverse outcomes, such as kidney failure, cardiovascular events, and death.ObjectiveTo evaluate a computerized clinical decision support (CDS) system for the management of uncontrolled hypertension in patients with CKD.Design, Setting, and ParticipantsThis multiclinic, randomized clinical trial randomized primary care practitioners (PCPs) at a primary care network, including 15 hospital-based, ambulatory, and community health center–based clinics, through a stratified, matched-pair randomization approach February 2021 to February 2022. All adult patients with a visit to a PCP in the last 2 years were eligible and those with evidence of CKD and hypertension were included.InterventionThe intervention consisted of a CDS system based on behavioral economic principles and human-centered design methods that delivered tailored, evidence-based recommendations, including initiation or titration of renin-angiotensin-aldosterone system inhibitors. The patients in the control group received usual care from PCPs with the CDS system operating in silent mode.Main Outcomes and MeasuresThe primary outcome was the change in mean systolic blood pressure (SBP) between baseline and 180 days compared between groups. The primary analysis was a repeated measures linear mixed model, using SBP at baseline, 90 days, and 180 days in an intention-to-treat repeated measures model to account for missing data. Secondary outcomes included blood pressure (BP) control and outcomes such as percentage of patients who received an action that aligned with the CDS recommendations.ResultsThe study included 174 PCPs and 2026 patients (mean [SD] age, 75.3 [0.3] years; 1223 [60.4%] female; mean [SD] SBP at baseline, 154.0 [14.3] mm Hg), with 87 PCPs and 1029 patients randomized to the intervention and 87 PCPs and 997 patients randomized to usual care. Overall, 1714 patients (84.6%) were treated for hypertension at baseline. There were 1623 patients (80.1%) with an SBP measurement at 180 days. From the linear mixed model, there was a statistically significant difference in mean SBP change in the intervention group compared with the usual care group (change, −14.6 [95% CI, −13.1 to −16.0] mm Hg vs −11.7 [−10.2 to −13.1] mm Hg; P = .005). There was no difference in the percentage of patients who achieved BP control in the intervention group compared with the control group (50.4% [95% CI, 46.5% to 54.3%] vs 47.1% [95% CI, 43.3% to 51.0%]). More patients received an action aligned with the CDS recommendations in the intervention group than in the usual care group (49.9% [95% CI, 45.1% to 54.8%] vs 34.6% [95% CI, 29.8% to 39.4%]; P &lt; .001).Conclusions and RelevanceThese findings suggest that implementing this computerized CDS system could lead to improved management of uncontrolled hypertension and potentially improved clinical outcomes at the population level for patients with CKD.Trial RegistrationClinicalTrials.gov Identifier: NCT03679247

show abstract

“…The Kidney-CHAMP study was conducted in 101 University of Pittsburgh Medical Center (UPMC)–affiliated primary care practices across Western Pennsylvania. The study protocol was published previously ( Supplement 1 , Supplement 2 , and Supplement 3 ) and approved by the University of Pittsburgh institutional review board and quality improvement committee. Results were reported using the Consolidated Standards of Reporting Trials ( CONSORT ) reporting guidelines.…”

Section: Methodsmentioning

confidence: 99%

Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Jhamb,

Weltman,

Devaraj

et al. 2024

JAMA Intern Med

Self Cite

View full text Add to dashboard Cite

ImportanceLarge gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes.ObjectiveTo compare the effectiveness of an electronic health record–based population health management intervention vs usual care for reducing CKD progression and improving evidence-based care in high-risk CKD.Design, Setting, and ParticipantsThe Kidney Coordinated Health Management Partnership (Kidney CHAMP) was a pragmatic cluster randomized clinical trial conducted between May 2019 and July 2022 in 101 primary care practices in Western Pennsylvania. It included patients aged 18 to 85 years with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2 with high risk of CKD progression and no outpatient nephrology encounter within the previous 12 months.InterventionsMultifaceted intervention for CKD comanagement with primary care clinicians included a nephrology electronic consultation, pharmacist-led medication management, and CKD education for patients. The usual care group received CKD care from primary care clinicians as usual.Main Outcomes and MeasuresThe primary outcome was time to 40% or greater reduction in eGFR or end-stage kidney disease.ResultsAmong 1596 patients (754 intervention [47.2%]; 842 control [52.8%]) with a mean (SD) age of 74 (9) years, 928 (58%) were female, 127 (8%) were Black, 9 (0.6%) were Hispanic, and the mean (SD) estimated glomerular filtration rate was 36.8 (7.9) mL/min/1.73m2. Over a median follow-up of 17.0 months, there was no significant difference in rate of primary outcome between the 2 arms (adjusted hazard ratio, 0.96; 95% CI, 0.67-1.38; P = .82). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker exposure was more frequent in intervention arm compared with the control group (rate ratio, 1.21; 95% CI, 1.02-1.43). There was no difference in the secondary outcomes of hypertension control and exposure to unsafe medications or adverse events between the arms. Several COVID-19–related issues contributed to null findings in the study.Conclusion and RelevanceIn this study, among patients with moderate-risk to high-risk CKD, a multifaceted electronic health record–based population health management intervention resulted in more exposure days to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers but did not reduce risk of CKD progression or hypertension control vs usual care.Trial RegistrationClinicalTrials.gov Identifier: NCT03832595

show abstract

Electronic health record based population health management to optimize care in CKD: Design of the Kidney Coordinated HeAlth Management Partnership (K-CHAMP) trial

Cited by 5 publications

References 42 publications

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study

Clinical Decision Support for Hypertension Management in Chronic Kidney Disease

Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Contact Info

Product

Resources

About