Regan Mary E
General Internal Medicine of Lancaster, Lancaster, Pennsylvania.
J Am Assoc Nurse Pract. 2017 Dec;29(12):741-753. doi: 10.1002/2327-6924.12505. Epub 2017 Sep 6.
Chronic kidney disease (CKD) is undertreated and under-recognized in primary care. The majority of primary care providers (PCPs) are not aware or knowledgeable of current CKD guidelines. The purpose of this project was to develop a quality improvement intervention for PCPs through the delivery of evidence-based guidelines at the point of care.
An evidence-based clinical algorithm was developed in the electronic medical record for providers to access within one organization comprising 11 primary care offices with 80 PCPs. Baseline knowledge surveys and baseline data were obtained in August 2016. A CKD educational intervention and tutorial on a clinical decision support (CDS) tool was presented to physicians, nurse practitioners, and physician assistants. Postimplementation data and knowledge surveys were collected in December 2016.
Most PCPs were willing to use a CKD CDS tool to help them with CKD patients. A CDS tool in addition to an educational intervention can improve PCP knowledge and identification of CKD and early referral to nephrology.
CDS tools can promote evidence-based guided care for PCPs and CKD patients. By using these applications, patients can be properly identified, managed, treated, and appropriately referred to nephrology.
慢性肾脏病（CKD）在初级保健中未得到充分治疗和认识。大多数初级保健提供者（PCP）不了解或不熟悉当前的CKD指南。本项目的目的是通过在医疗点提供循证指南，为PCP开发一种质量改进干预措施。
在电子病历中开发了一种循证临床算法，供一个由11个初级保健办公室和80名PCP组成的组织内的提供者使用。2016年8月获取了基线知识调查和基线数据。向医生、执业护士和医师助理提供了关于临床决策支持（CDS）工具的CKD教育干预和教程。2016年12月收集了实施后的数据和知识调查。
大多数PCP愿意使用CKD CDS工具来帮助他们管理CKD患者。除教育干预外，CDS工具可提高PCP对CKD的认识和识别能力，并促进早期转诊至肾病科。
CDS工具可为PCP和CKD患者促进循证指导护理。通过使用这些应用程序，可以正确识别、管理、治疗患者，并适当地转诊至肾病科。
