Chronic Kidney Disease (CKD) Guideline Adherence - A Quality Improvement Study

NCT00921687 | Completed Results

• 1 other identifier: LSCVAMCCKD1
• Study Type: interventional
• Target: 781
• Locations: 1 country
• Sites: 1

Brief Summary

Chronic kidney disease (CKD) is defined as kidney damage for greater than 3 months or a glomerular filtration rate less than 60 mL/min per 1.73m2 for greater than 3 months. Patients with CKD are at high risk for development of cardiovascular disease and metabolic complications. Guidelines for the care of patients with CKD have been developed by the National Kidney Foundation. Despite the wide availability of these guidelines, adherence is low. The goal of the current study is to evaluate whether a multifactorial intervention, including a CKD registry, will improve CKD guideline adherence. The hypothesis is that providers exposed to a multifactorial clinical intervention including education, academic detailing, and a CKD registry will be more likely to adhere to CKD guidelines than those only exposed to education.

Conditions

Chronic Renal Insufficiency

Outcome Measures

Primary Outcomes (1)

• PTH (Parathyroid Hormone) Adherence

  Probability for having a PTH measured during the study period comparing intervention vs control clinic during the study period as estimated by Generalized Estimating Equation (determines probability, not proportion). Participants assigned 1 if PTH was measured and 0 if PTH was not measured during the study period.

  One year

Secondary Outcomes (1)

• Last Clinic BP <130/80 mmHg

  One year

Study Arms (2)

Multifactorial intervention

EXPERIMENTAL

The multifactorial intervention will consist of a CKD lecture, the CKD reference card, academic detailing, and access to the CKD registry.

Behavioral: Multifactorial intervention

Education only

ACTIVE COMPARATOR

Providers in the education only arm will receive a CKD lecture and be given a CKD reference card.

Behavioral: Education only

Interventions

Education only BEHAVIORAL

The education will consist of a lecture and distribution of a CKD reference card.

Education only

Multifactorial intervention BEHAVIORAL

Providers in the intervention group will receive a lecture on CKD, a CKD reference card, academic detailing (residents only), and access to the CKD registry.

Multifactorial intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All primary care providers at the Wade Park Veterans Affairs Medical Center (VAMC) will be eligible for the study
• Patients:
• Receive primary care from a provider at the Wade Park VAMC
• Have:
• CKD as defined by an estimated glomerular filtration rate (eGFR) less than 60 on two separate occasions 90 to 730 days apart,
• diabetes, OR
• hypertension

You may not qualify if:

• End-stage renal disease
• Renal transplant recipients
• Less than 18 years of age on July 1, 2009
• No primary care visit between Jan 1, 2008 and July 1, 2009

Sponsors & Collaborators

• Louis Stokes VA Medical Center: lead

Study Sites (1)

Louis Stokes Cleveland Veterans Affairs Medical Center

Cleveland, Ohio, United States

Location

Related Publications (5)

• National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266. No abstract available.

  PMID: 11904577 BACKGROUND

• Hoy T, Fisher M, Barber B, Borker R, Stolshek B, Goodman W. Adherence to K/DOQI practice guidelines for bone metabolism and disease. Am J Manag Care. 2007 Nov;13(11):620-5.

  PMID: 17988187 BACKGROUND

• Philipneri MD, Rocca Rey LA, Schnitzler MA, Abbott KC, Brennan DC, Takemoto SK, Buchanan PM, Burroughs TE, Willoughby LM, Lentine KL. Delivery patterns of recommended chronic kidney disease care in clinical practice: administrative claims-based analysis and systematic literature review. Clin Exp Nephrol. 2008 Feb;12(1):41-52. doi: 10.1007/s10157-007-0016-3. Epub 2008 Jan 5.

  PMID: 18175059 BACKGROUND

• Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct 20;282(15):1458-65. doi: 10.1001/jama.282.15.1458.

  PMID: 10535437 BACKGROUND

• Drawz PE, Miller RT, Singh S, Watts B, Kern E. Impact of a chronic kidney disease registry and provider education on guideline adherence--a cluster randomized controlled trial. BMC Med Inform Decis Mak. 2012 Jul 5;12:62. doi: 10.1186/1472-6947-12-62.

  PMID: 22765882 DERIVED

Related Links

• abstract - BMC Medical Informatics and Decision Making

MeSH Terms

Conditions

Renal Insufficiency, Chronic

Condition Hierarchy (Ancestors)

Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Results Point of Contact

• Title: Paul Drawz, MD, MHS, MS
• Organization: Louis Stokes Cleveland VA Medical Center

draw0003@umn.edu

6126255423

Study Officials

• Paul E Drawz, MD, MHS, MS

  Louis Stokes VA Medical Center

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Instructor

Study Record Dates

• First Submitted: June 15, 2009
• First Posted: June 16, 2009
• Study Start: July 1, 2009
• Primary Completion: June 1, 2010
• Study Completion: June 1, 2010
• Last Updated: May 27, 2013
• Results First Posted: May 23, 2013

Record last verified: 2013-05

Locations

US (1)