Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
Contemp Clin Trials. 2023 Aug;131:107269. doi: 10.1016/j.cct.2023.107269. Epub 2023 Jun 20.
Primary care physicians (PCPs) provide the majority of medical care to patients with non-dialysis dependent CKD. However, PCPs report numerous limitations to providing expert CKD care, including poor patient education, inadequate diagnostic evaluation, suboptimal use of medications, and time limitations. The Kidney Coordinated HeAlth Management Partnership (Kidney CHAMP) trial is a cluster randomized controlled trial to evaluate the effectiveness of a novel centralized electronic health records (EHR)-delivered population health management (PHM) strategy for high-risk CKD patients on patient care, safety, and other outcomes of interest to patients, providers, and payors. Over a 42-month period, the trial will compare the effectiveness of a multifaceted intervention that combines early identification of high-risk patients, timely nephrology guidance, pharmacist-led medication management services, and CKD patient education to usual care and enroll 1650 high-risk CKD patients from 100 primary care practices. The primary outcome will be ≥40% decline in estimated glomerular filtration rate (eGFR) or end stage kidney disease. Key secondary outcomes will include blood pressure, renin-angiotensin aldosterone system inhibitors use, and exposure to potentially unsafe medications. If successful, our treatment approach could improve CKD care delivery and safety, resource allocation, and adoption of evidence-based CKD guideline-concordant care.
初级保健医生（PCP）为非透析依赖型慢性肾脏病（CKD）患者提供大部分医疗服务。然而，PCP 在提供专家 CKD 护理方面存在诸多限制，包括患者教育不足、诊断评估不充分、药物使用不理想以及时间限制等。肾脏协调健康管理伙伴关系（Kidney CHAMP）试验是一项集群随机对照试验，旨在评估一种新型集中式电子病历（EHR）提供的人群健康管理（PHM）策略，该策略针对高危 CKD 患者，用于评估其对患者护理、安全性以及患者、提供者和支付者关注的其他结果的有效性。在 42 个月的时间里，该试验将比较一种多方面干预措施的有效性，该措施结合了高危患者的早期识别、及时的肾脏病指导、药剂师主导的药物管理服务以及 CKD 患者教育，与常规护理进行比较，并招募来自 100 个初级保健实践的 1650 名高危 CKD 患者。主要结局将是估算肾小球滤过率（eGFR）下降≥40%或终末期肾病。关键次要结局将包括血压、肾素-血管紧张素-醛固酮系统抑制剂的使用以及接触潜在不安全药物。如果成功，我们的治疗方法可以改善 CKD 的护理提供和安全性、资源分配以及采用基于证据的 CKD 指南一致的护理。
