Making CKD Guidelines Work in Underserved Practices

State University Of New York At Buffalo, Buffalo NY

Investigators

Abstract

[unreadable] DESCRIPTION: (Provided by the Applicant) Chronic Kidney Disease (CKD) is a worldwide public health issue. It is two to four times more likely to burden minority populations. Primary care providers (PCPs) are largely unaware of evidence-based CKD guidelines. This pilot study will test implementing CKD guidelines with PCP-directed telephonic case management. This translational research into practice (TRIP) pilot study uses a randomized trial to evaluate the effect of a site-level intervention in a sample of practices in medically underserved communities (MUCs) within the Upstate New York Practice Based Research Network (UNYNET). These sites are located in rural and urban areas and include an over-sample of minority patients. The specific aims of this study are to: 1) estimate the effect size on patient outcomes resulting from implementing CKD guidelines; and 2) assess the usefulness of PCP-directed telephonic case management for CKD guideline utilization in primary care MUC settings. Outcomes measured for Aim #1 will be change in control of diabetes, hypertension, proteinuria, dyslipidemias, and anemia. Outcomes for Aim # 2 will be practice changes in the staging, treatment planning, and specialty consultation for CKD. Four sites will be randomized into two study conditions: guideline implementation and usual care. A consecutive sample of patients (18+) with CKD at each site will be asked to consent to have their medical record reviewed for guideline adherence over prior-year periods at baseline and post-intervention end points. Participatory research methods will be used to assess provider- and staff-identified barriers to implementation. The information gathered will serve as the basis for an ongoing translational research program that will lead to an R01 application. In addition to testing efficacy, this R01 application will also include a cost-effectiveness analysis. [unreadable] [unreadable] [unreadable]