Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

Not Applicable

Completed

• Conditions: Chronic Kidney Disease
• Interventions: Other: automated clinical alerts; Other: provider education

• Registration Number: NCT00688285
• Lead Sponsor: University of Pittsburgh

Brief Summary

To determine whether the use of educational sessions and computerized clinical reminders can improve primary care doctors' delivery of care to CKD patients compared to educational sessions alone. Hypothesis: Clinical reminders will improve the care delivered to CKD patients

Detailed Description

Literature supports that most chronic kidney disease (CKD) patients are cared for by primary care physicians (PCP) without the help of a kidney specialist. Many of these patients fail to achieve targeted outcomes and late referral to a nephrologist has been associated with an increased risk of death. Automated computerized clinical reminders have been shown to improve physician compliance with recommended guidelines in other settings.

Aims: To determine if clinical reminders can help PCPs decrease the rate of late referrals, improve urine albumin checks in CKD patients

Design: prospective randomized controlled, single-blinded study with additional historical control

Methods: Two 20-minute teaching sessions aimed at all GIM PCPs in the UPMC clinic followed by randomization of the eligible GIM providers to receive automated clinical reminders (CR) for their CKD stage 3b-5 patients versus routine care.

Outcomes: Using a database search, individuals with an eGFR\<45ml/min/1.73m2 (not seen by a nephrologist) will have data collected on: PCP referral to a nephrologist, urinary albumin (or protein) quantification in the past year, PCP recognition of patients with eGFR\<45ml/min, ACE/ARB usage.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2008-05-28
• Study First Submitted QC: 2008-05-30
• Study First Posted: 2008-06-02
• Study Start: 2008-12
• Primary Completion: 2009-12
• Study Completion: 2009-12
• Status Verified: 2011-03
• Last Update Submitted: 2011-03-24
• Last Update Posted: 2011-03-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 248

Inclusion Criteria

• For PCPs: all GIM attending physicians with a weekly continuity clinic.
• For patients: >= 18 years-old with an eGFR<45ml/min/1.73m2 being seen in the UPMC GIM clinic by a faculty member during the 10-month intervention period

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Exclusion Criteria

• for PCPs: imminent plans to leave the department
• patients with a renal transplant, on any form of dialysis, or with a previous nephrology evaluation.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
1	automated clinical alerts	education and automated clinical alerts
1	provider education	education and automated clinical alerts
2	provider education	education session alone

Primary Outcome Measures

Name	Time	Method
referral to a nephrologist	12 months	Referral to a nephrologist within the 12 months following decision support system activation.

Secondary Outcome Measures

Name	Time	Method
Use of ACE/ARB	12 months	Active use of ACE/ARB at the end of the 12 month period following decision support system activation.
Annual ACR or PCR check	12 months	ACR or PCR within 12months of the decision support system activation

Trial Locations

Locations (1)

University of Pittsburgh; 🇺🇸 Pittsburgh, Pennsylvania, United States