Evaluation of an Electronic CKD Clinical Decision Support System (CDSS) in Clinical Care (CDSSR18)
Hypertension, Renal Insufficiency, Chronic
About this trial
This is an interventional screening trial for Hypertension
Eligibility Criteria
Inclusion Criteria:
- Have at least two outpatient, documented eGFRcreat values 30- 59 ml/min/1.72m2 that are at least ≥3 months apart
- At least one of these measurements should be within 12 months.
- Patients have seen their primary care physician at least one time within the previous 18 months
- Patient's primary care providers agree to participate
Exclusion Criteria:
- Patients actively and recently seen by nephrology clinic (at least once in the past 12 months)
- Patients with a diagnosis of end stage renal disease
- Persons aged >80
- Persons with New York Heart Association (NYHA) class III or IV heart failure, known ejection fraction < 25%, or documented allergy to ace/arb.
- Patients on dialysis, kidney transplant recipients and pregnant women
- Patients with prevalent dementia, impaired cognition or severe mental illness; expected life expectancy < 6 months.
There will also be a category where the physician can opt out for specific patients in their panel due to not believing this person should be included in the study for any reason.
Sites / Locations
- UCSF Division of General Internal Medicine
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
No Intervention
Clinical Decision Support System (CDSS)
Clinic Decision Sup System + Pharmacist
Usual Care
PCPs get a notice the CKD Clinical Decision Support System (CDSS) is available. CDSS overview: The study MDs order CKD triple marker tests Patients will go to the lab as per usual clinical care Lab results are returned to PCPs clinical results folder as per usual clinical workflow with information about CKD and link to KDIGO guidelines Results will also be sent to the Study MD's for monitoring At the patient's next visit, if the labs are completed, the full CDSS launches for the PCP If the labs are not completed by the next visit, a Best Practice Alert (BPA) will launch for the PCP notifying them that the labs have been ordered, but the patient hasn't done them yet
The Clinical Decision Support System + Pharmacist follow-up call extends beyond the CDSS alone. CDSS Plus overview: At the visit in which the CDSS launches, the PCP will hand a study card with pharmacist information to their patient notifying them that a pharmacist will be calling to follow-up after the visit The pharmacist will use MyChart and/or phone calls to schedule a follow-up call within two weeks of the visit On the follow-up phone call, the pharmacist will discuss understanding of CKD, medication review and adherence assessment, home BP checks, and the importance of NSAID avoidance A second follow-up call will only be scheduled if the patient is non-adherent with their medications and makes an active plan for adherence with the pharmacist, or if the patient requests an additional call from the pharmacist
Patients continue to receive usual care by their provider.