Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

Chronic Kidney Disease Clinical Trial

— ACRinCKD  

Official title:

Automated Clinical Reminders in the Care of Chronic Kidney Disease Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00688285
• Other study ID #: PRO07110299
• Status: Completed
• Phase: N/A
• First received: May 28, 2008
• Last updated: March 24, 2011
• Start date: December 2008
• Est. completion date: December 2009

Study information

• Verified date: March 2011
• Source: University of Pittsburgh
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial 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

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 248
• Est. completion date: December 2009
• Est. primary completion date: December 2009
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

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

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.

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Chronic Kidney Disease
• Kidney Diseases
• Renal Insufficiency, Chronic

Intervention

Other:
• automated clinical alerts
automated clinical alerts in the electronic medical record
• provider education
PCP education session on CKD

Locations

Country	Name	City	State
United States	University of Pittsburgh	Pittsburgh	Pennsylvania

Sponsors (1)

Lead Sponsor	Collaborator
University of Pittsburgh

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	referral to a nephrologist	Referral to a nephrologist within the 12 months following decision support system activation.	12 months	No
Secondary	Use of ACE/ARB	Active use of ACE/ARB at the end of the 12 month period following decision support system activation.	12 months	No
Secondary	Annual ACR or PCR check	ACR or PCR within 12months of the decision support system activation	12 months	No