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Study: Use of CDS Tools Can Improve Management of Chronic Kidney Disease

October 12, 2016
by Heather Landi
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Early detection of chronic kidney disease can lead to interventions to prevent renal failure, and researchers have found that the use of clinical decision support tools (CDS) can improve identification of the disease, according to a study published in the Journal of the American Board of Family Medicine.

According to the research team, led by Cara Litvin, M.D., of the division of general internal medicine and geriatrics at the Medical University of South Carolina, the prevalence of chronic kidney disease is increasing in the United States, and in addition to being a risk factor for progression to end-stage renal disease, the condition also is a risk factor for cardiovascular disease. “The majority of patients with chronic kidney disease are managed solely by primary care physicians, yet primary care adherence to clinical practice guidelines seems to be suboptimal,” the study authors wrote.

The research team was focused on how interventions to improve the early identification and management of patients with chronic kidney disease could reduce risks for the progression of renal disease and cardiovascular disease, and, therefore, have a major impact on public health.

“Inadequate recognition of patients with chronic kidney disease and lack of awareness of treatment guidelines are two major barriers to providing quality care to patients with chronic kidney disease,” the study author wrote. “Electronic health record (EHR)-based reminders and clinical decision support (CDS) have been identified as potential tools to improve the identification of chronic kidney disease, facilitate monitoring, and improve adherence to treatment targets. To date, however, only a few small, single-site studies have evaluated the use of EHR-based tools to improve chronic kidney disease care, and none have assessed provider and staff perceptions of their use.”

For the study, the research team developed several EHR-based CDS tools, including a chronic kidney disease risk assessment tool, electronic health maintenance protocols, a chronic kidney disease patient registry and a chronic kidney disease flowchart. The tools included prompts for lipid, urine albumin and other testing.

The researchers deployed the CDS tools in 11 primary care practices for two years. The primary care practices were part of the Primary Care Practices Research Network (PPRNet), a national primary care practice-based research network, with all network members, at the time of the study, using a common EHR system.

The researchers concluded that the CDS tools “show promise for improving the identification of patients with chronic kidney disease in a group of diverse, ‘real-world’ primary care practice.”

According to the study, the interventions resulted in a dramatic increase in the number of patients at risk for and with chronic kidney disease who received testing for albuminuria, a major prognostic indicator for cardiovascular disease, progression of disease, and death. “Through this additional testing, practices participating in this study identified hundreds more patients meeting criteria for chronic kidney disease who may benefit from early interventions, such as blood pressure control, use of an ACEI or ARB, and assessment of cardiovascular risk factors,” the study authors wrote.

However, the tools didn’t help as much for other clinical quality measures.

The researchers also noted that the study had limitations, namely, the study was conducted with a small group of practices without a control group and considerable variability in practice characteristics including size, numbers and types of providers and specialty.

The study authors concluded,” Organizational, provider, patient, and technical factors beyond the CDS tools themselves may affect whether they can be effectively used to improve care. For example, achieving improvements in CKD outcomes such as blood pressure control likely requires an additional focus on improving care coordination between primary care physicians and nephrologists and encouraging patient activation. Further comparison studies are needed to evaluate multifaceted interventions designed to combine CDS tools with these additional components to effectively improve CKD management in primary care.”

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