Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Kidney Int. 2012 Jun;81(12):1245-7. doi: 10.1038/ki.2011.483. Epub 2012 Feb 15.
The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines suggest that clinicians use the estimated glomerular filtration rate (eGFR) measurements and minimize the use of timed urine creatinine clearance collection. The intent of this change was to improve recognition of chronic kidney disease. Here we used time-series modeling and intervention analyses to determine the effect of publication of the K/DOQI guidelines and the introduction of widespread eGFR reporting with prompts on physician ordering of 24-h urine collection for creatinine clearance. In this setting, clinical practice guidelines did not influence creatinine clearance testing; however, the direct introduction of eGFR reporting with prompts into physician workflow resulted in a sudden and significant 23.5% decrease in creatinine clearance collection over the 43 months analyzed. Thus, eGFR reporting with prompts may have produced a clinical practice change because it is integrated directly into physician workflow. Changing physician practice patterns may require more than publishing guidelines; rather it is more likely to occur through educational and structural changes to practice.
肾脏病预后质量倡议（K/DOQI）指南建议临床医生使用估算肾小球滤过率（eGFR）测量值，并尽量减少使用定时尿肌酐清除率收集。这一改变的目的是提高对慢性肾脏病的认识。在这里，我们使用时间序列建模和干预分析来确定 K/DOQI 指南的发布以及广泛使用带有提示的 eGFR 报告对医生开具 24 小时尿液收集进行肌酐清除率检测的影响。在这种情况下，临床实践指南并没有影响肌酐清除率检测；然而，直接将带有提示的 eGFR 报告引入医生的工作流程，导致在分析的 43 个月内肌酐清除率检测突然显著下降了 23.5%。因此，带有提示的 eGFR 报告可能已经产生了临床实践的改变，因为它直接集成到了医生的工作流程中。改变医生的实践模式可能需要不仅仅是发布指南；更有可能通过教育和结构改变来实现。
