Dataset Information

Integrated Digital Health System Tools to Support Decision Making and Treatment Preparation in CKD: The PREPARE NOW Study.

ABSTRACT:

Rationale & objective

Digital health system tools to support shared decision making and preparation for kidney replacement treatments for patients with chronic kidney disease (CKD) are needed.

Study design

Descriptive study of the implementation of digital infrastructure to support a patient-centered health system intervention.

Setting & participants

4 CKD clinics within a large integrated health system.

Exposure

We developed an integrated suite of digital engagement tools to support patients' shared decision making and preparation for kidney failure treatments. Tools included an automated CKD patient registry and risk prediction algorithm within the electronic health record (EHR) to identify and prioritize patients in need of nurse case management to facilitate shared decision making and preparation for kidney replacement treatments, an electronic patient-facing values clarification tool, a tracking application to document patients' preparation for treatments, and an EHR work flow to broadcast patients' treatment preferences to all health care providers.

Outcomes

Uptake and acceptability.

Analytic approach

Mixed methods.

Results

From July 1, 2017, through June 30, 2018, the CKD registry identified 1,032 patients in 4 nephrology clinics, of whom 243 (24%) were identified as high risk for progressing to kidney failure within 2 years. Kidney Transitions Specialists enrolled 117 (48%) high-risk patients by the end of year 1. The values tool was completed by 30/33 (91%) patients who attended kidney modality education. Nurse case managers used the tracking application for 100% of patients to document 287 planning steps for kidney replacement therapy. Most (87%) high-risk patients had their preferred kidney replacement modality documented and displayed in the EHR. Nurse case managers reported that the tools facilitated their identification of patients needing support and their navigation activities.

Limitations

Single institution, short duration.

Conclusions

Digital health system tools facilitated rapid identification of patients needing shared and informed decision making and their preparation for kidney replacement treatments.

Funding

This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Project Program Award (IHS-1409-20967).

Trial registration

ClinicalTrials.gov NCT02722382.

SUBMITTER: Green JA

PROVIDER: S-EPMC8350843 | biostudies-literature |

REPOSITORIES: biostudies-literature

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