Ongoing Projects: Electronic Health Record Research and Pragmatic Trials

Lowering Blood Pressure Among Hypertensives with Screen-Detected Kidney Disease

Principal Investigator: Carmen Peralta

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (5R34DK102152)

Project Summary: We designed a pragmatic, cluster-randomized clinical trial to improve BP control for non-diabetic, hypertensive adults with screen-detected CKD in primary care. The first intervention will evaluate the efficacy of a nurse-led screen-and-educate strategy that utilizes a “triple-marker” CKD screening approach, coupled with both patient and provider education, compared with usual care. The second intervention will evaluate whether a screen, educate, and intensify treatment program co-led by both a nurse and a clinical pharmacist can improve BP management among persons with highest risk CKD, compared with the screen-and-educate strategy and with usual care. Based on the Chronic Care Model for primary care, this project is specifically designed to leverage an existing multi-disciplinary team to improve BP levels and increase appropriate use of inhibitors of the renin-angiotensin system (ACE/ARB). We will also evaluate the feasibility and process implementation of these programs using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. If successful, these interventions could help to reduce the burden of CKD and its associated complications.

Design of Pragmatic Randomized Clinical trial to Evaluate the Effectiveness of A CKD Electronic Clinical Decision Support System (CDSS) in Primary Care

Principal Investigator: Carmen Peralta

Funding Source: UCSF Clinical &Translational Science Institute

Project Summary: We aim to design, develop and implement an automated chronic kidney disease (CKD) testing and education decision support system tool in primary care. The CDSS will utilize the electronic medical record to facilitate test ordering, implementation and provider and patient education.

An Electronic Clinical Decision Support System (CDSS) to Lower Blood Pressure in Persons with CKD in Primary Care: A Randomized Trial

Principal Investigator: Carmen Peralta and Leah Karliner

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (1R18DK110959)

Project Summary: The overall goal of this proposal is to evaluate two strategies designed to reduce barriers to guideline- concordant chronic kidney disease (CKD) care among persons with previously documented reduced eGFRcreat (creatinine-based estimated glomerular filtration rate) in primary care. We will test whether or not an automated CKD clinical decision support system (CDSS) can improve blood pressure (BP) levels, disease awareness, staging, processes of care, and knowledge among persons with documented reduced eGFRcreat in primary care. We propose a three-arm, pragmatic, cluster-randomized clinical trial. Participating primary care providers (PCP) will be randomized to usual care or one of two interventions. The first intervention will evaluate the efficacy of an automated CDSS that utilizes the electronic health record to facilitate triple marker test ordering (creatinine, cystatin C and albuminuria for disease staging), guideline implementation and BP management, compared with usual care, among patients with previous eGFRcreat <60 ml/min/1.73m2. The second intervention goes a step further, and it will evaluate whether a CDSS plus a pharmacist-led CKD management program (CDSS PLUS) can improve BP management and patient CKD and non-steroidal anti-inflammatory drug (NSAID) toxicity knowledge among persons with confirmed higher-risk CKD (eGFRcreat-cys <45 or eGFR45- 59 plus ACR ≥30), compared with CDSS alone.