Health information technology (IT) offers new tools to improve outcomes in chronic diseases, yet few IT applications have been designed specifically for the chronic kidney disease (CKD) population, which includes many patients adversely affected by the Digital Divide and at risk for medication errors. Application type: K23 Mentored Patient-Oriented Research Career Development Award. Career development aim: Develop skills in the evaluation, development, and implementation of health IT solutions to improve the safety of care in CKD through a unique didactic curriculum and execution of a novel prospective study plan.
Study aims : 1) examine the association between surveyed perceived e-literacy and medication errors in individuals with CKD, 2) assess the relationship between functional computer literacy and medication errors in individuals with CKD using performance assessment of a simple website-based task list, and 3) pilot a novel IT prototype medication inquiry system (MIS) which provides precautionary information on the safe usage medications common in CKD. Core study and population: Chronic Renal Insufficiency Cohort (CRIC) study, which is a nationally cohort of adult participants with CKD. Research methods:
Aim 1 : Survey CRIC participants from 4 CRIC sites (n=1150) at an annual visit regarding their mobile phone usage, and perceived e-health literacy with the validated eHealth Literacy Scale (eHEALS).
Aim 2 : Assess the human-computer interactions of participants at three CRIC centers (n=195) accessing an eCRIC' website and a structured assignment list, designed to measure participants' computer proficiency. Evaluate the association between Aims 1 & 2 measures and degree of cumulative threat to safety defined by a novel medication error classification scheme.
Aim 3 : evaluate local CRIC participants (n = 50) effective use of a novel MIS application embedded on a personal digital assistant-based (e.g. iPod Touch), which notifies users about the safety of specific medications upon input of their actual medications with CAUTION or NOT SAFE alerts. Correctness of reported results will be verified by study staff. Career development plan: Multidisciplinary mentorship team and curriculum has been assembled to foster Dr. Diamantidis' working knowledge of healthcare informatics, patient engagement methodology, and mobile technology applications. The mentorship team will oversee Dr. Diamantidis in her professional development and acquisition of a working understanding of health IT and its application to chronic disease populations. These acquired competencies will enhance her current background in clinical epidemiology. Anticipated results: This Mentored Patient-Oriented Research Career Development Award will help Dr. Diamantidis achieve her immediate and long term goals by supporting: 1) new and unique training in health IT research, 2) multidisciplinary collaboration with expert informatics researchers, 3) advanced training in epidemiology and 4) the generation of critical preliminary data to facilitate her transition to research independence with a specialized niche in implementation of disease-tailored health IT applications in CKD.

Public Health Relevance

Individuals with CKD are at risk for adverse safety events, yet little is known regarding the utility of health information technology (IT) educational tools to reduce these events. The results of this project will be invaluable in gaining a better understanding of the limitations and potential for use of health IT in individuals with a spectrum of medication errors, and lead to tailored health IT tools to reduce the high rate of adverse safety events in CKD.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK-D)
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Rankin, Tracy L
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Diamantidis, Clarissa J; Bosworth, Hayden B; Oakes, Megan M et al. (2018) Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study: Protocol and baseline characteristics of a randomized controlled trial. Contemp Clin Trials 69:28-39
Duronville, John V; Diamantidis, Clarissa J (2018) Medical safety in the care of the person with end-stage kidney disease. Semin Dial 31:140-148
Diamantidis, Clarissa Jonas (2017) A Fundamental Theorem of Telehealth. Adv Chronic Kidney Dis 24:4-5
Crowley, Matthew J; Diamantidis, Clarissa J; McDuffie, Jennifer R et al. (2017) Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease: A Systematic Review. Ann Intern Med 166:191-200
Wang, Virginia; Diamantidis, Clarissa J; Wylie, JaNell et al. (2017) Minding the gap and overlap: a literature review of fragmentation of primary care for chronic dialysis patients. BMC Nephrol 18:274
Zullig, Leah L; Diamantidis, Clarissa J; Bosworth, Hayden B et al. (2017) Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study. J Clin Hypertens (Greenwich) 19:1327-1335