Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD

Clinical journal of the American Society of Nephrology: CJASN

Sankar D. Navaneethan⁵ 

[1] and..;and..§Department of Quantitative Health Sciences, and..‖Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;and..¶Personal Connected Health Alliance of Healthcare Information and Management Systems Society, Cleveland, Ohio..‖Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;and..‖Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;*Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas;‡Department of General Internal Medicine, Medicine Institute,..§Department of Quantitative Health Sciences, and..§Department of Quantitative Health Sciences, and..‖Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio

关键词: kidney disease;    navigator;    personal health record;    Aged;    Ambulatory Care Facilities;    Cost-Benefit Analysis;    Electronic Health Records;    Emergency Service, Hospital;    Follow-Up Studies;    Health Records, Personal;    hospitalization;    Humans;    Nephrologists;    nephrology;    Outcome Assessment (Health Care);    Patient Care Planning;    Patient Navigation;    Primary Health Care;    Referral and Consultation;    renal dialysis;    Renal Insufficiency, Chronic;    Renin-Angiotensin System;   

DOI  :  10.2215/CJN.02100217

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record–based enhanced personal health record to disseminate CKD stage–specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4.Design, setting, participants, & measurements Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: (1) enhanced personal health record only, (2) patient navigator only, (3) both, and (4) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates.Results Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups (P=0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups.Conclusions We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators and patient education through an enhanced personal health record in those with CKD.

【 授权许可】

CC BY