Chronic kidney disease is steadily increasing in prevalence in the United States, causing significant morbidity and mortality. Stage 3 chronic kidney disease is associated with a 5-year all-cause mortality rate of 24.3% and a 5-year need for renal replacement of 1.3%. Stage 4 chronic kidney disease is associated with a 5-year 45.7% mortality rate and a 5-year 19.9% requirement for renal replacement. There is reasonable evidence that specific actions can be implemented by primary care physicians to delay chronic kidney disease progression and reduce mortality;however, chronic kidney disease is under-recognized and under-treated in primary care offices. The availability of computer decision support (CDS) for chronic kidney disease may help promote effective, evidence-based care, but evidence suggests that CDS alone may not be enough to improve quality of care. Studies have shown improvement in diabetes care from a combination of CDS plus practice facilitation. Studies of similar interventions for chronic kidney disease care have not been conducted. This group randomized controlled trial will test the extent to which CDS plus practice facilitation promotes evidence- based care and improves the clinical outcomes of reduced disease progression and mortality in primary care practices. The practice facilitation intervention is based on an effective approach for implementing the Chronic Care Model;it is a combination of CDS plus having practice facilitators work with on-site teams lead by a physician champion. In addition, each practice will be assigned an academic mentor and have routine audit and feedback of key elements of evidence-based chronic kidney disease care. Evaluation will include an intent-to-treat and process analysis between the CDS practices with facilitation versus the CDS-only practices of the clinical outcomes of chronic kidney disease progression and all-cause mortality. A cost- effectiveness analysis will compare the benefit of the intervention of CDS alone against the intervention of CDS plus practice facilitation in relationship to overall cost per quality adjusted years of life. This study will enroll 40 practices associated with the Distributed Ambulatory Research in Therapeutics Network (DARTNet), a federated network of organizations that use electronic health records.
Chronic Kidney Disease (CKD) is a serious medical condition, usually accompanied by other health problems, that is increasing in prevalence and costliness to the US health care system. Although there are known cost-effective treatments to prevent the progression of CKD, this condition is often under-recognized and under-treated in Primary Care Physician (PCP) offices. The proposed research will study various approaches primary care physicians can take to improve the care they provide to patients with CKD and it will also seek to determine which of those treatments are most effective in improving patient outcomes.
|Loskutova, Natalia Y; Smail, Craig; Ajayi, Kemi et al. (2018) Recruiting primary care practices for practice-based research: a case study of a group-randomized study (TRANSLATE CKD) recruitment process. Fam Pract 35:111-116|
|Satchidanand, Nikhil; Withiam-Leitch, Matthew; Dickinson, Miriam et al. (2016) Positive Predictive Value of a Single Assessment of Estimated GFR in the Diagnosis of Chronic Kidney Disease. South Med J 109:351-5|
|Dickinson, L Miriam; Beaty, Brenda; Fox, Chet et al. (2015) Pragmatic Cluster Randomized Trials Using Covariate Constrained Randomization: A Method for Practice-based Research Networks (PBRNs). J Am Board Fam Med 28:663-72|
|Vest, Bonnie M; York, Trevor R M; Sand, Jessica et al. (2015) Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study. J Am Board Fam Med 28:624-31|
|Kahn, Linda S; Vest, Bonnie M; Madurai, Nethra et al. (2015) Chronic kidney disease (CKD) treatment burden among low-income primary care patients. Chronic Illn 11:171-83|
|Cipparone, Charlotte W; Withiam-Leitch, Matthew; Kimminau, Kim S et al. (2015) Inaccuracy of ICD-9 Codes for Chronic Kidney Disease: A Study from Two Practice-based Research Networks (PBRNs). J Am Board Fam Med 28:678-82|
|Mahoney, Martin C; Masucci Twarozek, Annamaria; Saad-Harfouche, Frances et al. (2014) Assessing the delivery of cessation services to smokers in urban, safety-net clinics. J Community Health 39:879-85|
|Krist, Alex H; Beasley, John W; Crosson, Jesse C et al. (2014) Electronic health record functionality needed to better support primary care. J Am Med Inform Assoc 21:764-71|
|Fox, Chester; Vassalotti, Joseph (2014) Checklists as computer decision support at the point of care: a step forward in the recognition and treatment of CKD by primary care physicians. Clin J Am Soc Nephrol 9:1505-6|
|Fox, Chester H; Vest, Bonnie M; Kahn, Linda S et al. (2013) Improving evidence-based primary care for chronic kidney disease: study protocol for a cluster randomized control trial for translating evidence into practice (TRANSLATE CKD). Implement Sci 8:88|
Showing the most recent 10 out of 11 publications