BMC Med Inform Decis Mak - Impact of a chronic kidney disease registry and provider education on guideline adherence--a cluster randomized controlled trial.


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CKGROUND: 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 12month 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.

Resumo Limpo

ckground low adher chronic kidney diseas ckd guidelin may due unrecogn ckd lack guidelin awar part provid goal studi evalu impact provid educ access ckd registri guidelin adherencemethod conduct cluster random control trial loui stoke cleveland vamc one two primari care clinic random intervent provid clinic receiv lectur ckd guidelin studi initi provid intervent clinic given access shown use ckd registri identifi patient ckd automat updat daili elig patient least one primari care visit last year ckd base egfr receiv renal replac therapi primari outcom parathyroid hormon pth adher defin least one pth measur month studi secondari outcom measur phosphorus hemoglobin proteinuria achiev goal blood pressur treatment diuret reninangiotensin system blockerresult elig patient seen studi control intervent clinic respect compar preintervent measur pth increas clinic control clinic intervent clinic patient intervent clinic like pth measur studi adjust odd ratio ci p howev intervent associ consist improv secondari outcom provid intervent clinic access registryconclus intervent includ educ ckd guidelin access ckd patient registri margin improv guidelin adher educ alon adher primari process measur improv clinic improv seen intermedi clinic outcom improv care patient ckd will like requir multifacet approach includ system redesign clinicaltrialsgov registr number nct

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