Complex Interventions Across Primary and Secondary Care to Optimize Population Kidney Health

Taylor, Dominic; Nimmo, Ailish; Caskey, Fergus; Johnson, Rachel; Pippias, Maria; Meléndez-Torres, G J

doi:10.2215/cjn.0000000000000136

Cited by 7 publications

(3 citation statements)

References 94 publications

(223 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We incorporated several components to optimize population-level value-based kidney health as identified in a recent systematic review, including automated detection of higher-risk cases, educational support, non-patient-facing nephrologist review, and dynamic integration with existing workflows. 33 Clinician learning during the process of treating patients was promoted by incorporating education in the electronic consultations. Moreover, the intervention was designed based on pilot work that demonstrated high need and receptiveness of this program among PCCs and incorporated feedback from PCCs and health system and health informatics leadership teams to ensure harmonization with PCC workflow.…”

Section: Discussionmentioning

confidence: 99%

“…Participating primary care practices were also heterogenous in terms of academic affiliation, geographical location, access to specialists, practice size, and use of physician extenders, thus supporting the generalizability of our findings. We incorporated several components to optimize population-level value-based kidney health as identified in a recent systematic review, including automated detection of higher-risk cases, educational support, non–patient-facing nephrologist review, and dynamic integration with existing workflows . Clinician learning during the process of treating patients was promoted by incorporating education in the electronic consultations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Jhamb,

Weltman,

Devaraj

et al. 2024

JAMA Intern Med

View full text Add to dashboard Cite

ImportanceLarge gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes.ObjectiveTo compare the effectiveness of an electronic health record–based population health management intervention vs usual care for reducing CKD progression and improving evidence-based care in high-risk CKD.Design, Setting, and ParticipantsThe Kidney Coordinated Health Management Partnership (Kidney CHAMP) was a pragmatic cluster randomized clinical trial conducted between May 2019 and July 2022 in 101 primary care practices in Western Pennsylvania. It included patients aged 18 to 85 years with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2 with high risk of CKD progression and no outpatient nephrology encounter within the previous 12 months.InterventionsMultifaceted intervention for CKD comanagement with primary care clinicians included a nephrology electronic consultation, pharmacist-led medication management, and CKD education for patients. The usual care group received CKD care from primary care clinicians as usual.Main Outcomes and MeasuresThe primary outcome was time to 40% or greater reduction in eGFR or end-stage kidney disease.ResultsAmong 1596 patients (754 intervention [47.2%]; 842 control [52.8%]) with a mean (SD) age of 74 (9) years, 928 (58%) were female, 127 (8%) were Black, 9 (0.6%) were Hispanic, and the mean (SD) estimated glomerular filtration rate was 36.8 (7.9) mL/min/1.73m2. Over a median follow-up of 17.0 months, there was no significant difference in rate of primary outcome between the 2 arms (adjusted hazard ratio, 0.96; 95% CI, 0.67-1.38; P = .82). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker exposure was more frequent in intervention arm compared with the control group (rate ratio, 1.21; 95% CI, 1.02-1.43). There was no difference in the secondary outcomes of hypertension control and exposure to unsafe medications or adverse events between the arms. Several COVID-19–related issues contributed to null findings in the study.Conclusion and RelevanceIn this study, among patients with moderate-risk to high-risk CKD, a multifaceted electronic health record–based population health management intervention resulted in more exposure days to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers but did not reduce risk of CKD progression or hypertension control vs usual care.Trial RegistrationClinicalTrials.gov Identifier: NCT03832595

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Jhamb,

Weltman,

Devaraj

et al. 2024

JAMA Intern Med

View full text Add to dashboard Cite

show abstract

“…Recent work by investigators from the United Kingdom suggested that automatic identification of individuals at high risk of CKD progression and CV risk is important for improving CKD care [ 18 ]. The investigators performed a systematic review and realist synthesis to develop an integrated model of intervention mechanisms to improve the delivery of CKD care.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Klinrisk chronic kidney disease progression model in the FIDELITY population

Tangri,

Ferguson,

Leon

et al. 2024

Clinical Kidney Journal

View full text Add to dashboard Cite

Background Chronic kidney disease (CKD) affects > 800 million individuals worldwide and is often under-recognized. Early detection, identification, and treatment can delay disease progression. Klinrisk is a proprietary risk prediction model based on common laboratory data to predict CKD progression. We aimed to externally validate the Klinrisk model for prediction of CKD progression in FIDELITY (a prespecified pooled analysis of two finerenone phase III trials in patients with CKD and type 2 diabetes). In addition, we sought to identify evidence of an interaction between treatment and risk. Methods The validation cohort included all participants in FIDELITY up to 4 years. The primary and secondary composite outcomes included a ≥ 40% decline in estimated glomerular filtration rate (eGFR) or kidney failure, and a ≥ 57% decline in eGFR or kidney failure. Prediction discrimination was calculated using area under the receiver operating characteristic curve (AUC). Calibration plots were calculated by decile comparing observed with predicted risk. Results At time horizons of 2 and 4 years, 993 and 1795 patients experienced a primary outcome event, respectively. The model predicted the primary outcome accurately with an AUC of 0.81 for 2 years and 0.86 for 4 years. Calibration was appropriate at both 2 and 4 years, with Brier scores of 0.067 and 0.115, respectively. No evidence of interaction between treatment and risk was identified for the primary composite outcome (P = 0.31). Conclusions Our findings demonstrate the accuracy and utility of a laboratory-based prediction model for early identification of patients at the highest risk of CKD progression.

show abstract

General practitioners’ representation of early-stage CKD is a barrier to adequate management and patient empowerment: a phenomenological study

Oude Engberink,

Tessier,

Kamil

et al. 2024

J Nephrol

View full text Add to dashboard Cite

Complex Interventions Across Primary and Secondary Care to Optimize Population Kidney Health

Abstract: Visual Abstract

Cited by 7 publications

References 94 publications

Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Validation of the Klinrisk chronic kidney disease progression model in the FIDELITY population

General practitioners’ representation of early-stage CKD is a barrier to adequate management and patient empowerment: a phenomenological study

Contact Info

Product

Resources

About