Chronic Kidney Disease Clinical Decision Support (CKD-CDS)
Chronic Kidney Diseases, Hypertension, Diabetes
About this trial
This is an interventional health services research trial for Chronic Kidney Diseases focused on measuring Chronic Kidney Disease, CKD, Clinical Decision Support, Diabetes, Hypertension
Eligibility Criteria
Inclusion Criteria:
- Age 18 to 75 years, inclusive. The evidence-based guidelines on which the CDS intervention is based are not applicable outside this age range.
- Have confirmed CKD based on 2 or more eGFR values <60 cc/min/1.73m2, including the most recent eGFR value and a previous eGFR at least one week prior
Have a CKD care component suboptimally managed as defined by one or more of the following:
- Have two or more BP values from separate encounter dates of >=130/80 including the most recent BP to the index visit
- Have an individualized A1C over goal as determined by CDS algorithm criteria of most recent glycated hemoglobin (A1C) > 7% OR > 8% if any of the following conditions are identified: cardiovascular disease (CVD) or calculated 10-yr atherosclerotic cardiovascular disease (ASCVD) risk >30%, cancer, hypoglycemia, cognitive impairment, on 2 or more glycemia medications with insulin, or on 3 or more non-insulin glycemia medications
- Have most recent eGFR 30-59 with hypertension identified or ACR > 30 mg/g and not on an ACEI or ARB
- Have non-steroidal anti-inflammatory drug (NSAID) other than aspirin on the active medication list
- Have a eGFR 15-29 or ACR > 300 mg/g without a nephrology visit in the last 12 months
Exclusion Criteria:
An individual who meets any of the following criteria will be excluded from receiving the
CKD-CDS:
- Patients enrolled in hospice,
- Patients with active cancer or undergoing chemotherapy
- Patients with pregnancy in the last year
- Patients with end stage renal disease
Individuals who meet all inclusion and exclusion criteria at an index visit and have at least one post-index visit in the following 12 months will be included in the primary analyses.
Sites / Locations
- HealthPartners Care System
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
CKD enhanced clinical decision support (CKD-CDS Intervention)
Usual Care
Priority Wizard CDS tool is enhanced to incorporate chronic kidney disease(CKD) management. This presents patients and their primary care providers (PCPs) multiple opportunities to consider an evolving array of timely, evidence-based treatment options to improve CKD care. The CDS also provides CV risk factor management like the basic Priority Wizard present in the usual care arm.
A basic Priority Wizard CDS tool for cardiovascular (CV) risk factor management (previously know as the CV Wizard) includes algorithmically derived identification of high CV risk patients and prioritized treatment suggestions for lipids, Blood Pressure (BP), glycemic control, weight, tobacco, and aspirin use based on distance from goal, current medications, labs, allergies, and safety considerations. Has no decision support specific to CKD care.