Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical Trial

Samal, Lipika; D'Amore, John D.; Gannon, Michael P.; Kilgallon, John L.; Charles, J.‐P.; Mann, Devin; Siegel, Lydia C.; Burdge, Kelly A.; Shaykevich, Shimon; Lipsitz, Stuart R.; Waikar, Sushrut S.; Bates, David W.; Wright, Adam

doi:10.1016/j.xkme.2022.100493

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…Past studies for improving CKD care have had mixed success in improving the quality of care or clinical outcomes. [17][18][19][20][21]23,36 Carroll et al 37 conducted one of to our knowledge the few large clinical implementation studies comparing CDS alone vs with practice facilitation in more than 6600 patients with CKD who were followed for 2 years. Although the study showed a positive effect on reducing CKD progression, it required a resourceintensive on-site coordinator, and results were limited due to significant dropout and lack of usual care control.…”

Section: Discussionmentioning

confidence: 99%

“…Past studies for improving CKD care have had mixed success in improving the quality of care or clinical outcomes . Carroll et al conducted one of to our knowledge the few large clinical implementation studies comparing CDS alone vs with practice facilitation in more than 6600 patients with CKD who were followed for 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16] Use of EHR-based population health management (PHM) is a potentially high-effect, low-cost, scalable intervention that can standardize CKD management across a health system and improve efficiency of resource allocation. Prior studies using individual-level strategies, such as CDS, [17][18][19][20][21] pharmacist support, 22,23 and nephrology guidance, 24 had mixed success in improving quality of care. This may be partly due to the lack of multifaceted intervention at the health system, clinician, and patient level.…”

mentioning

confidence: 99%

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Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Jhamb,

Weltman,

Devaraj

et al. 2024

JAMA Intern Med

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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

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Jhamb,

Weltman,

Devaraj

et al. 2024

JAMA Intern Med

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“… 10 , 38 , 42 , 50 , 51 , 68 , 69 The use of KFRE is limited among primary care providers, resulting in patients rarely receiving referrals to nephrology, or being referred much later than is ideal for disease management. 53 , 58 , 70 , 71 , 72 Like many other CDS tools, there is enormous potential to improve patient outcomes and provider workflows through KFRE integration in primary care settings, as previous research involving this tool has shown promising results. 56 …”

Section: History Of Emrsmentioning

confidence: 99%

“… 48 , 51 , 61 These findings are also comparable to various other ongoing and completed studies in North America, Asia, the United Kingdom, and Australia. 50 , 58 , 59 , 66 , 72 …”

Section: History Of Emrsmentioning

confidence: 99%