Impact of a chronic kidney disease registry and provider education on guideline adherence - A cluster randomized controlled trial

Paul E. Drawz, R. Tyler Miller, Simran Singh, Brook Watts, Elizabeth Kern

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Low adherence to chronic kidney disease (CKD) guidelines may be due to unrecognized CKD and lack of guideline awareness on the part of providers. The goal of this study was to evaluate the impact of provider education and access to a CKD registry on guideline adherence. Methods. We conducted a cluster randomized controlled trial at the Louis Stokes Cleveland VAMC. One of two primary care clinics was randomized to intervention. Providers from both clinics received a lecture on CKD guidelines at study initiation. Providers in the intervention clinic were given access to and shown how to use a CKD registry, which identifies patients with CKD and is automatically updated daily. Eligible patients had at least one primary care visit in the last year, had CKD based on eGFR, and had not received renal replacement therapy. The primary outcome was parathyroid hormone (PTH) adherence, defined by at least one PTH measurement during the 12 month study. Secondary outcomes were measurement of phosphorus, hemoglobin, proteinuria, achievement of goal blood pressure, and treatment with a diuretic or renin-angiotensin system blocker. Results: There were 418 and 363 eligible patients seen during the study in the control and intervention clinics, respectively. Compared to pre-intervention, measurement of PTH increased in both clinics (control clinic: 16% to 23%; intervention clinic: 13% to 28%). Patients in the intervention clinic were more likely to have a PTH measured during the study (adjusted odds ratio = 1.53; 95% CI (1.01, 2.30); P = 0.04). However, the intervention was not associated with a consistent improvement in secondary outcomes. Only 5 of the 37 providers in the intervention clinic accessed the registry. Conclusions: An intervention that included education on CKD guidelines and access to a CKD patient registry marginally improved guideline adherence over education alone. Adherence to the primary process measure improved in both clinics, but no improvement was seen in intermediate clinical outcomes. Improving the care of patients with CKD will likely require a multifaceted approach including system redesign. ClinicalTrials.Gov registration number. NCT00921687.

Original languageEnglish (US)
Article number62
JournalBMC Medical Informatics and Decision Making
Volume12
Issue number1
DOIs
StatePublished - 2012

Fingerprint

Guideline Adherence
Chronic Renal Insufficiency
Registries
Randomized Controlled Trials
Education
Parathyroid Hormone
Guidelines
Primary Health Care
Process Assessment (Health Care)
Renal Replacement Therapy
Renin-Angiotensin System
Proteinuria
Diuretics
Phosphorus
Patient Care
Hemoglobins
Odds Ratio
Blood Pressure

Keywords

  • Chronic kidney disease
  • Electronic health records
  • Health services research
  • Randomized controlled trial

ASJC Scopus subject areas

  • Health Informatics
  • Health Policy

Cite this

Impact of a chronic kidney disease registry and provider education on guideline adherence - A cluster randomized controlled trial. / Drawz, Paul E.; Miller, R. Tyler; Singh, Simran; Watts, Brook; Kern, Elizabeth.

In: BMC Medical Informatics and Decision Making, Vol. 12, No. 1, 62, 2012.

Research output: Contribution to journalArticle

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