Optimizing Referral Pathways for Patients With Hematuria and Moderate-Severe Proteinuria

NCT07431931 | Not Yet Recruiting

• 1 other identifier: HEORUSV201555
• Study Type: interventional
• Target: 1,200
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of the study is to evaluate prospectively the impact of an electronic health record (EHR) alert on primary care providers' (PCP) referral to Nephrology of Geisinger patients with high risk signs (blood and protein in the urine) of glomerulonephritis. This will help quantify the relative effectiveness of EHR alerts on PCPs' referral patterns.

Conditions

Referral and Consultation; Glomerulonephritis; Hematuria; Proteinuria; Kidney Disease

Keywords

Hematuria; Proteinuria; Albuminuria; Glomerulonephritis; Clinical Decision Support; EHR Alert; Referral; Nephrology

Outcome Measures

Primary Outcomes (1)

• Referral to Nephrology

  Proportion of adult patients with high-risk features for glomerulonephritis with a nephrology referral order

  Within One month of index PCP visit

Other Outcomes (8)

• 3-6 month Nephrology referral

  Within 3 and 6 months of index PCP visit

• Nephrology referral completion

  Within 3 and 6 months of index PCP visit

• Time to referral to nephrology

  Within 12 months of index PCP visit

Study Arms (2)

Patients with PCP receiving EHR Alert

EXPERIMENTAL

Other: Electronic Health Record alert

Patients receiving usual care

NO INTERVENTION

Patient will receive usual care

Interventions

Electronic Health Record alert OTHER

The EHR alert will open upon logging into patient's chart. It will display relevant information about hematuria (dipstick blood), urine microscopy (if available), proteinuria (ACR, PCR, dipstick protein), most recent (if ever) nephrology visit, and most recent (if ever) urology visit. The EHR alert will provide a preselected order button for a nephrology referral with the indication pre-filled out. It will also provide options to order confirmatory urinalysis with microscopy testing and an option to refer to urology. The provider will have an option to deselect the nephrology referral, which will prompt reasons for not ordering the referral: "Not appropriate"; "already seeing a nephrologist"; "palliative care"; "patient refuses"; "Other (document)". The alert will not be a hard-stop in the chart.

Patients with PCP receiving EHR Alert

Eligibility Criteria

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

You may qualify if:

• Adults aged ≥18 years
• Patients receiving care from any Geisinger primary care provider (record of an encounter with a Geisinger PCP within the last 2 years from date of survey implementation)
• Patients with high-risk glomerulonephritis features i.e. positive test results for hematuria (urine dipstick result with blood 1+ or greater) and proteinuria (2+ or 3+ protein on dipstick or ACR≥300 mg/g or PCR ≥500 mg/g) collected within 12 months of index date.

You may not qualify if:

• Patients with a nephrologist appointment in the last 12 months before the index date
• Patients with a prior appointment with a nephrologist within the last 2 years before the positive urinalysis test for hematuria (1+ or greater)
• Patients with a history of glomerulonephritis and/or kidney failure (dialysis or eGFR \< 15 mL/min/1.73m2, or kidney transplantation) at any time during the baseline
• Patients receiving palliative care at any time during the baseline

Sponsors & Collaborators

• Geisinger Clinic: lead
• Novartis: collaborator

Study Sites (1)

Geisinger Medical Center

Danville, Pennsylvania, 17822, United States

Location

MeSH Terms

Conditions

Glomerulonephritis; Hematuria; Proteinuria; Kidney Diseases; Albuminuria

Condition Hierarchy (Ancestors)

Nephritis; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Urination Disorders; Hemorrhage; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Urological Manifestations; Signs and Symptoms

Central Study Contacts

Alexander Chang, MD

CONTACT

570-214-3156; achang@geisinger.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: SCREENING
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Geisinger primary care providers assigned to the EHR alert intervention will receive an automated alert when conducting a visit with a patient meeting eligibility criteria. The EHR alert will open upon logging into patient's chart. It will display relevant information about hematuria (dipstick blood), urine microscopy (if available), proteinuria (ACR, PCR, dipstick protein), most recent (if ever) nephrology visit, most recent (if ever) urology) visit. The EHR alert will provide a preselected order button for a nephrology referral with the indication pre-filled out. It will also provide options to order confirmatory urinalysis with microscopy testing and an option to refer to urology. The provider will have an option to deselect the nephrology referral, which will prompt reasons for not ordering the referral: "Not appropriate"; "already seeing a nephrologist"; "palliative care"; "patient refuses"; "Other (document)". The alert will not be a hard-stop in the chart.

Study Record Dates

• First Submitted: February 10, 2026
• First Posted: February 25, 2026
• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2027
• Last Updated: February 25, 2026

Record last verified: 2026-02

Locations

US (1)