Tuot Delphine S, Crowley Susan T, Katz Lois A, Leung Joseph, Alcantara-Cadillo Delly K, Ruser Christopher, Talbot-Montgomery Elizabeth, Vassalotti Joseph A
University of California, San Francisco, San Francisco, CA, United States.
Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.
JMIR Res Protoc. 2020 Oct 19;9(10):e22024. doi: 10.2196/22024.
Patient awareness, clinician detection, and management of chronic kidney disease remain suboptimal, despite clinical practice guidelines and diverse education programs.
This protocol describes a study to develop and investigate the impact of the National Kidney Foundation Kidney Score Platform on chronic kidney disease awareness, communication, and management, by leveraging the Behavior Change Wheel, an implementation science framework that helps identify behavioral intervention targets and functions that address barriers to behavior change.
We interviewed 20 patients with chronic kidney disease and 11 clinicians to identify patient and clinician behaviors suitable for intervention and barriers to behavior change (eg, limited awareness of chronic kidney disease clinical practice guidelines within primary care settings, limited data analytics to highlight chronic kidney disease care gaps, asymptomatic nature of chronic kidney disease in conjunction with patient reliance on primary care clinicians to determine risk and order kidney testing). Leveraging the Behavior Change Wheel, the Kidney Score Platform was developed with a patient-facing online Risk Calculator and a clinician-facing Clinical Practice Toolkit. The Risk Calculator utilizes risk predictive analytics to provide interactive health information tailored to an individual's chronic kidney disease risk and health status. The Clinical Practice Toolkit assists clinicians in discussing chronic kidney disease with individuals at risk for and with kidney disease and in managing their patient population with chronic kidney disease. The Kidney Score Platform will be tested in 2 Veterans Affairs primary health care settings using a pre-post study design. Outcomes will include changes in patient self-efficacy for chronic kidney disease management (primary outcome), quality of communication with clinicians about chronic kidney disease, and practitioners' knowledge of chronic kidney disease guidelines. Process outcomes will identify usability and adoption of different elements of the Kidney Score Platform using qualitative and quantitative methods.
As of September 2020, usability studies are underway with veterans and clinicians to refine the patient-facing components of the Kidney Score Platform before study initiation. Results and subsequent changes to the Kidney Score Platform will be published at a later date. The study is expected to be completed by December 2021.
Results of this study will be used to inform integration of the Kidney Score Platform within primary care settings so that it can serve as a central component of the National Kidney Foundation public awareness campaign to educate, engage, and empower individuals at risk for and living with chronic kidney disease.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/22024.
尽管有临床实践指南和各种教育项目，但慢性肾脏病患者的知晓率、临床医生的检测率及管理水平仍不尽人意。
本方案描述了一项研究，旨在通过利用行为改变轮（一种实施科学框架，有助于确定行为干预目标及解决行为改变障碍的功能）来开发并研究美国国家肾脏基金会肾脏评分平台对慢性肾脏病知晓率、沟通及管理的影响。
我们采访了20例慢性肾脏病患者和11名临床医生，以确定适合干预的患者和临床医生行为以及行为改变的障碍（例如，初级保健机构内对慢性肾脏病临床实践指南的认识有限、用于突出慢性肾脏病护理差距的数据分析有限、慢性肾脏病的无症状性质以及患者依赖初级保健临床医生来确定风险并安排肾脏检测）。利用行为改变轮，开发了肾脏评分平台，包括一个面向患者的在线风险计算器和一个面向临床医生的临床实践工具包。风险计算器利用风险预测分析来提供针对个人慢性肾脏病风险和健康状况的交互式健康信息。临床实践工具包帮助临床医生与有慢性肾脏病风险的人和患有慢性肾脏病的人讨论慢性肾脏病，并管理他们的慢性肾脏病患者群体。肾脏评分平台将在2个退伍军人事务初级卫生保健机构中采用前后对照研究设计进行测试。结果将包括患者对慢性肾脏病管理的自我效能感的变化（主要结果）、与临床医生就慢性肾脏病沟通的质量以及从业者对慢性肾脏病指南的了解。过程结果将使用定性和定量方法确定肾脏评分平台不同要素的可用性和采用情况。
截至2020年9月，正在对退伍军人和临床医生进行可用性研究，以便在研究开始前完善肾脏评分平台面向患者的组件。肾脏评分平台的结果及后续更改将在以后公布。该研究预计于2021年12月完成。
本研究结果将用于指导肾脏评分平台在初级保健机构中的整合，使其能够作为美国国家肾脏基金会公众宣传活动的核心组成部分，以教育、吸引和赋能有慢性肾脏病风险的人和患有慢性肾脏病的人。
国际注册报告识别号（IRRID）：PRR1-10.2196/22024
