Implementing an evidence-based clinical decision support tool to improve the detection, evaluation, and referral patterns of adult chronic kidney disease patients in primary care

Abstract

Background and purpose Chronic kidney disease (CKD) is undertreated and under‐recognized in primary care. The majority of primary care providers (PCPs) are not aware or knowledgeable of current CKD guidelines. The purpose of this project was to develop a quality improvement intervention for PCPs through the delivery of evidence‐based guidelines at the point of care. Methods An evidence‐based clinical algorithm was developed in the electronic medical record for providers to access within one organization comprising 11 primary care offices with 80 PCPs. Baseline knowledge surveys and baseline data were obtained in August 2016. A CKD educational intervention and tutorial on a clinical decision support (CDS) tool was presented to physicians, nurse practitioners, and physician assistants. Postimplementation data and knowledge surveys were collected in December 2016. Conclusions Most PCPs were willing to use a CKD CDS tool to help them with CKD patients. A CDS tool in addition to an educational intervention can improve PCP knowledge and identification of CKD and early referral to nephrology. Implications for practice CDS tools can promote evidence‐based guided care for PCPs and CKD patients. By using these applications, patients can be properly identified, managed, treated, and appropriately referred to nephrology.

Complex Interventions Across Primary and Secondary Care to Optimize Population Kidney Health

“…The study selection process (Figure 2) identified 60 studies 31–90 for inclusion, including 56 original articles 31–36,38–51,53–55,57–63,65–90 and four abstracts. 37,52,56,...…”

Chronic Kidney Disease: Detection and Evaluation

“…In 2016, the Evidence Based Practice Project implemented a clinical decision tool for CKD into the electronic medical record system of primary care physicians, physician assistants, and nurse practitioners. 21 One of the goals of this program is to educate providers on the risk factors, staging, management, and outcomes of their patients with CKD in order to improve early detection rates and long term management. 21 As a result of this project, more patients were correctly diagnosed with CKD, detection rates improved, and appropriate referrals to nephrologists increased.…”

“…21 One of the goals of this program is to educate providers on the risk factors, staging, management, and outcomes of their patients with CKD in order to improve early detection rates and long term management. 21 As a result of this project, more patients were correctly diagnosed with CKD, detection rates improved, and appropriate referrals to nephrologists increased. This showed that evidence-based medicine is a valuable tool for primary care providers, especially when implemented into electronic medical record systems.…”

“…This showed that evidence-based medicine is a valuable tool for primary care providers, especially when implemented into electronic medical record systems. 21 While the current gold standard for diagnosis of CKD is a renal biopsy, recent studies present magnetic resonance imaging (MRI) as a less invasive alternative. 22 Implementation of a non-invasive modality, such as MRI, is proposed to decrease the number of undiagnosed cases of CKD in the population.…”

Application of a Computerized Decision Support System to Develop Care Strategies for Elderly Hemodialysis Patients

“…Demiris et al constructed a pulse recognition model using BP networks to improve the efficiency and accuracy of pulse diagnosis [ 16 ]. Regan constructed a pulse classification model by combining convolutional neural networks and recursive graphs, which further improved the efficiency and accuracy of pulse diagnosis [ 17 ]. Loftus et al constructed a tongue classifier using vectorized neural networks and achieved very promising results [ 18 ].…”