Improving evidence-based primary care for chronic kidney disease: study protocol for a cluster randomized control trial for translating evidence into practice (TRANSLATE CKD)

Implementation Science

Kevin Peterson³  Natalia Loskutova⁴  Joseph Vassalotti¹  Kim Kimminau⁷  Wilson Pace⁴  Hai Fang²  L Miriam Dickinson⁶  Linda S Kahn⁵  Bonnie M Vest⁵  Chester H Fox⁵ 

[1] National Kidney Foundation, New York, USA;Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA;Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA;American Academy of Family Physicians National Research Network, Leawood, USA;Department of Family Medicine, State University of New York – University at Buffalo, 77 Goodell St, Buffalo, NY 14203, USA;Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA;Department of Family Medicine, University of Kansas School of Medicine, Kansas, USA

关键词: Computer decision support;    Academic detailing;    Practice facilitation;    Practice based research networks;    Chronic kidney disease;   

Others  :  813441
DOI  :  10.1186/1748-5908-8-88

 received in 2013-05-23, accepted in 2013-07-17,  发布年份 2013

【 摘 要 】

Background

Chronic kidney disease (CKD) and end stage renal disease (ESRD) are steadily increasing in prevalence in the United States. While there is reasonable evidence that specific activities can be implemented by primary care physicians (PCPs) to delay CKD progression and reduce mortality, CKD is under-recognized and undertreated in primary care offices, and PCPs are generally not familiar with treatment guidelines. The current study addresses the question of whether the facilitated TRANSLATE model compared to computer decision support (CDS) alone will lead to improved evidence-based care for CKD in primary care offices.

Methods/Design

This protocol consists of a cluster randomized controlled trial (CRCT) followed by a process and cost analysis. Only practices providing ambulatory primary care as their principal function, located in non-hospital settings, employing at least one primary care physician, with a minimum of 2,000 patients seen in the prior year, are eligible. The intervention will occur at the cluster level and consists of providing CKD-specific CDS versus CKD-specific CDS plus practice facilitation for all elements of the TRANSLATE model. Patient-level data will be collected from each participating practice to examine adherence to guideline-concordant care, progression of CKD and all-cause mortality. Patients are considered to meet stage three CKD criteria if at least two consecutive estimated glomerular filtration rate (eGFR) measurements at least three months apart fall below 60 ml/min. The process evaluation (cluster level) will determine through qualitative methods the fidelity of the facilitated TRANSLATE program and find the challenges and enablers of the implementation process. The cost-effectiveness analysis will compare the benefit of the intervention of CDS alone against the intervention of CDS plus TRANSLATE (practice facilitation) in relationship to overall cost per quality adjusted years of life.

Discussion

This study has three major innovations. First, this study adapts the TRANSLATE method, proven effective in diabetes care, to CKD. Second, we are creating a generalizable CDS specific to the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines for CKD. Additionally, this study will evaluate the effects of CDS versus CDS with facilitation and answer key questions regarding the cost-effectiveness of a facilitated model for improving CKD outcomes. The study is testing virtual facilitation and Academic detailing making the findings generalizable to any area of the country.

Trial registration

Registered as NCT01767883 on clinicaltrials.gov NCT01767883

【 授权许可】

   
2013 Fox et al.; licensee BioMed Central Ltd.

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