Enhanced Dynamic Clinical Decision Support System Pragmatic Trial (E-DYNAMIC)

Status unconfirmed · Not applicable

Conditions studied: Chronic Kidney Diseases

In brief

Chronic kidney disease (CKD) is a highly prevalent, poorly recognized and undertreated and increases risk of atherosclerotic cardiovascular disease (ASCVD) and mortality. ASCVD risk interventions such as statin medications are not effective if initiated when kidney disease is advanced. Thus, early recognition of CKD is important for effective ASCVD risk management. Patient centered medical homes (PCMH)s (clinics which include nurse educators, dietitians, pharmacists and social workers) were designed to address gaps in care for complex chronic diseases such as CKD by increasing availability of ancillary services for patients. However, PCMH models have not been shown to improve the recognition and treatment of CKD and its associated ASCVD risk. The E DYNAMIC CDS retrieves real-time patient data from the electronic health record (EHR) every 24 hours to help primary care providers (PCP) identify patients with CKD and assess ASCVD risk and provide appropriate treatment. E-DYNAMIC also delegates CKD care with utilization of an opt-out approach for nurse education and dietitian referral. The overall objective of this pragmatic trial is to examine whether the E-DYNAMIC CDS increases PCP recognition of CKD and use of ASCVD risk management interventions when implemented within a PCMH. This pragmatic trial will be conducted within the Hines VA Hospital and community-based outpatient clinics designed as PCMH called teamlets. Teamlets include several PCPs, a nurse educator, a dietitian, a pharmacist, and a social worker. We will randomize 51 teamlets to the E-DYNAMIC CDS or to standard care. This pragmatic trial will address the following aims: 1) Determine the difference in PCP diagnosis of CKD stage 3-5 non-dialysis dependent CKD by allocation to the E-DYNAMIC CDS; 2) Determine the difference in PCPs ASCVD risk management of patients with stage 3-5 non-dialysis dependent CKD by teamlet allocation to the E-DYNAMIC CDS; 3) Determine the difference in patient use of ASCVD risk interventions and patient activation measures by their teamlet allocation to the E-DYNAMIC CDS. The primary outcomes of the pragmatic trial will be ascertained from the EHR. The E-DYNAMIC CDS tool may be transferred into other health systems that utilize an EHR and improve the diagnosis and management of CKD.

Key facts

Study ID

NCT03826758

Run by

Loyola University

People needed

8000

Starts

2021-01-01

Expected to finish

2023-09-30

Last updated by the study team

2020-08-27

Who can join

Age: 50 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• All patients with chronic kidney disease (50 years and older, non-dialysis dependent and who had not received kidney transplant) seen by the primary care providers during the study period will be included in this study.
• Practicing primary provider at any of the Edward Hines Jr. hospital outpatient clinics or community based outpatient clinics
• Willing to be involved in the E-DYNAMIC clinical trial

You may not qualify if…

• Provider not willing to be involved in the E-DYNAMIC clinical trial

Where it is running

• Edward Hines Jr. Hospital and associated Community Outpatient Based Clinics — Hines, Illinois, United States

Full record on ClinicalTrials.gov

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