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首页> 外文期刊>BMC Medical Informatics and Decision Making >Impact of a chronic kidney disease registry and provider education on guideline adherence – a cluster randomized controlled trial
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Impact of a chronic kidney disease registry and provider education on guideline adherence – a cluster randomized controlled trial

机译：慢性肾脏病登记和提供者教育对指南依从性的影响–一项随机对照试验

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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
机译：背景技术慢性肾脏病（CKD）指南的依从性差可能是由于未认识到CKD以及提供者方面缺乏指南意识。这项研究的目的是评估提供者教育和访问CKD注册中心对准则遵循的影响。方法我们在Louis Stokes Cleveland VAMC进行了一项整群随机对照试验。两家初级保健诊所之一被随机分配进行干预。两家诊所的提供者在研究开始时都接受了有关CKD指南的讲座。干预诊所的提供者可以访问并显示如何使用CKD注册中心，该注册中心可识别患有CKD的患者，并每天自动更新。符合条件的患者在去年至少进行了一次初级保健就诊，接受了基于eGFR的CKD，并且未接受肾脏替代治疗。主要结局是甲状旁腺激素（PTH）的依从性，其定义是在12个月的研究期间至少进行一次PTH测量。次要结果是测量磷，血红蛋白，蛋白尿，达到目标血压以及用利尿剂或肾素-血管紧张素系统阻滞剂治疗。结果研究期间，在对照和干预诊所中分别有418名和363名合格患者。与干预前相比，两家诊所的PTH值均增加（对照诊所：16％至23％;干预诊所：13％至28％）。在研究期间，干预诊所的患者更有可能测得PTH（校正后的优势比== 1.53; 95％CI（1.01、2.30）; P == 0.04）。但是，干预与次要结局的持续改善无关。干预诊所的37位提供者中只有5位访问了注册表。结论一项包括对CKD指南进行教育并获得CKD患者登记册的干预措施，与单纯接受教育相比，可以稍微提高指南的依从性。在两个诊所中，对主要过程指标的依从性均得到改善，但在中间临床结果中未见改善。改善CKD患者的护理可能需要采用多方面的方法，包括系统重新设计。 ClinicalTrials.Gov注册号NCT00921687

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