This career development award expands upon the candidate's current experience in areas of health services research including improving quality using electronic medical records. The award will further focus the candidate's career development in the areas of quality improvement and health information technology (HIT). All of the goals of this application have been designed to provide the candidate with the training necessary to become an expert on how HIT can be most effectively utilized to improve the delivery of quality healthcare. The short term goal for the four year course of this award is for the candidate to become an independent investigator, capable of leading large scale quality improvement projects and directing a primary care practice-based research network (PBRN). During this award period, the candidate plans to publish 5-7 manuscripts based on the results of this research project. By the end of this award period, the candidate also expects to have obtained subsequent grant support to broadly implement and assess the utility of clinical decision support (CDS) tools on the management of chronic diseases. Training activities proposed in this application include continued supervised mentoring by successful health services researchers, coursework including obtaining a Graduate Certificate in Medical Informatics, and presentation of findings at both seminars and national meetings. The purpose of the activities proposed in the research proposal is to identify methods to improve the identification and subsequent management of patients with chronic kidney disease (CKD) in primary care practices across the United States, focusing on how HIT, and more specifically CDS tools embedded in an electronic medical record, can be employed to achieve this goal. The findings from these planned activities are likely to be applicable to any chronic disease.
The specific aims for the research plan for this award include (1) selecting a set of CKD quality indicators for primary care, (2) incorporating these CKD indicators in quarterly practice performance reports distributed to primary care practices within a PBRN, (3) developing CDS tools that can be used to enhance care of patients with CKD in primary care, and (4) implementing and evaluating the impact of these clinical decision support tools in ten of these practices using validated interventions. This award addresses the Agency for Healthcare Research and Quality's (AHRQ) mission to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans, and is primarily intended to address the AHRQ's """"""""Health Information Technology"""""""" priority area of interest, particularly addressing how HIT can be used to improve health care decision making. In addition, since both patient education and prescribing recommendations are a component of the planned intervention, the project will also address research areas (1) HIT to improve the quality and safety of medication management and (2) HIT to support patient-centered care. Moreover, although responsive to the AHRQ's HIT area of interest, this research plan is also consistent with other AHRQ portfolios, including comparative effectiveness, prevention and care management, and innovations and emerging ideas. Consistent with AHRQ's goals, the research project is designed to improve the quality of healthcare for all Americans and to promote evidence-based decision making.

Public Health Relevance

/ Relevance Statement Because chronic kidney disease affects a significant proportion of the population, and early interventions can reduce subsequent risks for progressive renal and cardiovascular disease, the interventions to improve the identification and management of patients with early chronic kidney disease which are developed during this research project could have a major public health impact. This research project will also clarify how health information technology, particularly clinical decision support tools, can most effectively be used to improve primary care practice. In addition, since physician reimbursement for electronic medical record use will likely soon require use of clinical decision support tools, the project may also have health policy importance and relevance for many practicing physicians.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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HSR Health Care Research Training SS (HCRT)
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Anderson, Kay
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Medical University of South Carolina
Internal Medicine/Medicine
Schools of Medicine
United States
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Litvin, Cara B; Hyer, J Madison; Ornstein, Steven M (2016) Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD). J Am Board Fam Med 29:604-12
Litvin, Cara B; Ornstein, Steven M; Wessell, Andrea M et al. (2015) ""Meaningful"" clinical quality measures for primary care physicians. Am J Manag Care 21:e583-90
Ornstein, Steven M; Nemeth, Lynne S; Nietert, Paul J et al. (2015) Learning from primary care meaningful use exemplars. J Am Board Fam Med 28:360-70
Litvin, Cara B; Ornstein, Steven M (2014) Quality indicators for primary care: an example for chronic kidney disease. J Ambul Care Manage 37:171-8
Litvin, Cara B; Ornstein, Steven M; Wessell, Andrea M et al. (2013) Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: the ABX-TRIP study. J Gen Intern Med 28:810-6