ACRinCKD: Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

Sponsor

University of Pittsburgh (Other)

Overall Status

Completed

CT.gov ID

NCT00688285

Collaborator

(none)

248

Enrollment

Location

Arms

Duration (Months)

20.7

Patients Per Site Per Month

Study Details

Study Description

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

Condition or Disease	Intervention/Treatment	Phase
Chronic Kidney Disease	Other: automated clinical alerts Other: provider education	N/A

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.

Study Design

Study Type:

Interventional

Actual Enrollment :

248 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Single (Outcomes Assessor)

Primary Purpose:

Health Services Research

Official Title:

Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

Study Start Date :

Dec 1, 2008

Actual Primary Completion Date :

Dec 1, 2009

Actual Study Completion Date :

Dec 1, 2009

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: 1 education and automated clinical alerts	Other: automated clinical alerts automated clinical alerts in the electronic medical record Other: provider education PCP education session on CKD
Active Comparator: 2 education session alone	Other: provider education PCP education session on CKD

Arm

Intervention/Treatment

Active Comparator: 1

education and automated clinical alerts

Other: automated clinical alerts

automated clinical alerts in the electronic medical record

Other: provider education

PCP education session on CKD

Active Comparator: 2

education session alone

Other: provider education

PCP education session on CKD

Outcome Measures

Primary Outcome Measures

referral to a nephrologist [12 months]
Referral to a nephrologist within the 12 months following decision support system activation.

Secondary Outcome Measures

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

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

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