Dataset Information

Impact of a Primary Care CKD Registry in a US Public Safety-Net Health Care Delivery System: A Pragmatic Randomized Trial.

ABSTRACT:

Background

Many individuals with chronic kidney disease (CKD) do not receive guideline-concordant care. We examined the impact of a team-based primary care CKD registry on clinical measures and processes of care among patients with CKD cared for in a public safety-net health care delivery system.

Study design

Pragmatic trial of a CKD registry versus a usual-care registry for 1 year.

Setting & participants

Primary care providers (PCPs) and their patients with CKD in a safety-net primary care setting in San Francisco.

Intervention

The CKD registry identified at point of care all patients with CKD, those with blood pressure (BP)>140/90mmHg, those without angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) prescription, and those without albuminuria quantification in the past year. It also provided quarterly feedback pertinent to these metrics to promote "outreach" to patients with CKD. The usual-care registry provided point-of-care cancer screening and immunization data.

Outcomes

Changes in systolic BP at 12 months (primary outcome), proportion of patients with BP control, prescription of ACE inhibitors/ARBs, quantification of albuminuria, severity of albuminuria, and estimated glomerular filtration rate.

Results

The patient population (n=746) had a mean age of 56.7±12.1 (standard deviation) years, was 53% women, and was diverse (8% non-Hispanic white, 35.7% black, 24.5% Hispanic, and 24.4% Asian). Randomization to the CKD registry (30 PCPs, 285 patients) versus the usual-care registry (49 PCPs, 461 patients) was associated with 2-fold greater odds of ACE inhibitor/ARB prescription (adjusted OR, 2.25; 95% CI, 1.45-3.49) and albuminuria quantification (adjusted OR, 2.44; 95% CI, 1.38-4.29) during the 1-year study period. Randomization to the CKD registry was not associated with changes in systolic BP, proportion of patients with uncontrolled BP, or degree of albuminuria or estimated glomerular filtration rate.

Limitations

Potential misclassification of CKD; missing baseline medication data; limited to study of a public safety-net health care system.

Conclusions

A team-based safety-net primary care CKD registry did not improve BP parameters, but led to greater albuminuria quantification and more ACE inhibitor/ARB prescriptions after 1 year. Adoption of team-based CKD registries may represent an important step in translating evidence into practice for CKD management.

SUBMITTER: Tuot DS

PROVIDER: S-EPMC6057801 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Impact of a Primary Care CKD Registry in a US Public Safety-Net Health Care Delivery System: A Pragmatic Randomized Trial.

Tuot Delphine S DS McCulloch Charles E CE Velasquez Alexandra A Schillinger Dean D Hsu Chi-Yuan CY Handley Margaret M Powe Neil R NR

American journal of kidney diseases : the official journal of the National Kidney Foundation 20180423 2

<h4>Background</h4>Many individuals with chronic kidney disease (CKD) do not receive guideline-concordant care. We examined the impact of a team-based primary care CKD registry on clinical measures and processes of care among patients with CKD cared for in a public safety-net health care delivery system.<h4>Study design</h4>Pragmatic trial of a CKD registry versus a usual-care registry for 1 year.<h4>Setting & participants</h4>Primary care providers (PCPs) and their patients with CKD in a safety ...[more]

PMID: 29699885

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Dataset Information

Impact of a Primary Care CKD Registry in a US Public Safety-Net Health Care Delivery System: A Pragmatic Randomized Trial.

Background

Study design

Setting & participants

Intervention

Outcomes

Results

Limitations

Conclusions

Publications

Impact of a Primary Care CKD Registry in a US Public Safety-Net Health Care Delivery System: A Pragmatic Randomized Trial.

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