Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care
Abstract Background Chronic kidney disease (CKD) is a global health problem affected by under-recognition and under-treatment in primary care settings. Electronic clinical decision support (CDS) triggering systems have the potential to improve detection and management of people with CKD by assisting...
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2024-11-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-024-03852-z |
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| author | Jacob Andersson-Emad Arvid Thunholm Stephen Nash Marie Evans Sara Lind af Hageby Johan Ärnlöv Marie Hilderman Martin Forseth Arvid Sjölander Stefan H. Jacobson Juan Jesus Carrero |
| author_facet | Jacob Andersson-Emad Arvid Thunholm Stephen Nash Marie Evans Sara Lind af Hageby Johan Ärnlöv Marie Hilderman Martin Forseth Arvid Sjölander Stefan H. Jacobson Juan Jesus Carrero |
| author_sort | Jacob Andersson-Emad |
| collection | DOAJ |
| description | Abstract Background Chronic kidney disease (CKD) is a global health problem affected by under-recognition and under-treatment in primary care settings. Electronic clinical decision support (CDS) triggering systems have the potential to improve detection and management of people with CKD by assisting clinicians in adhering to guideline recommendations. We aimed to test whether an electronic CDS triggering system would improve the detection, recognition, and management of patients with CKD in primary care. Method/Design This is a pragmatic cluster-randomized controlled trial where 66 primary healthcare centers from the Stockholm Region, Sweden were randomized 1:1 to receive either a new expanded CDS-triggering system offering kidney-specific advice or to continue with their current CDS-triggering system. The expanded CDS system reminds and provides practical facilitators of the processes of CKD screening, recognition with a diagnosis, management and referral to specialist care. The trial duration is 24 months and it is embedded into the Stockholm CREAtinine measurements (SCREAM) project, a repository of healthcare data from the region, which minimizes disturbances with healthcare praxis due to the trial and makes it fully pragmatic. The primary outcomes are the number of eligible patients screened for creatinine and albuminuria once annually and the re-testing of these labs within 6 months in patients with abnormal eGFR or albuminuria. Secondary outcomes are the proportions of issued clinical diagnoses among those fulfilling criteria, proportions of patients with significant albuminuria receiving prescribed nephroprotective medications, proportions of accepted referrals to nephrologist care among those fulfilling criteria and proportion of referrals for ultrasound of the kidneys. Discussion Prior pragmatic trials of CDS-systems in CKD has shown an improvement in quality indicators primarily in patients already diagnosed with CKD. This study expands this evidence by focusing on the process of screening, identification, monitoring and diagnostic work-up. Conclusion This pragmatic trial will assess the value of CDS for improved adherence to CKD guidelines in primary care. Clinicaltrials.gov registration: NCT06386172, submitted 2024-04-23. |
| format | Article |
| id | doaj-art-f7af8fa254cf44b18fcf5f24f7292259 |
| institution | Kabale University |
| issn | 1471-2369 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj-art-f7af8fa254cf44b18fcf5f24f72922592024-11-17T12:14:41ZengBMCBMC Nephrology1471-23692024-11-0125111210.1186/s12882-024-03852-zStudy protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary careJacob Andersson-Emad0Arvid Thunholm1Stephen Nash2Marie Evans3Sara Lind af Hageby4Johan Ärnlöv5Marie Hilderman6Martin ForsethArvid Sjölander7Stefan H. Jacobson8Juan Jesus Carrero9Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetBlackwell MedtechDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDepartment of Clinical Science, Intervention and Technology, Karolinska InstitutetDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDepartment of Neurobiology, Care Sciences and Society, Karolinska InstitutetDivision of Nephrology, Department of Clinical Sciences, Karolinska Institutet Danderyd HospitalDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDivision of Nephrology, Department of Clinical Sciences, Karolinska Institutet Danderyd HospitalDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetAbstract Background Chronic kidney disease (CKD) is a global health problem affected by under-recognition and under-treatment in primary care settings. Electronic clinical decision support (CDS) triggering systems have the potential to improve detection and management of people with CKD by assisting clinicians in adhering to guideline recommendations. We aimed to test whether an electronic CDS triggering system would improve the detection, recognition, and management of patients with CKD in primary care. Method/Design This is a pragmatic cluster-randomized controlled trial where 66 primary healthcare centers from the Stockholm Region, Sweden were randomized 1:1 to receive either a new expanded CDS-triggering system offering kidney-specific advice or to continue with their current CDS-triggering system. The expanded CDS system reminds and provides practical facilitators of the processes of CKD screening, recognition with a diagnosis, management and referral to specialist care. The trial duration is 24 months and it is embedded into the Stockholm CREAtinine measurements (SCREAM) project, a repository of healthcare data from the region, which minimizes disturbances with healthcare praxis due to the trial and makes it fully pragmatic. The primary outcomes are the number of eligible patients screened for creatinine and albuminuria once annually and the re-testing of these labs within 6 months in patients with abnormal eGFR or albuminuria. Secondary outcomes are the proportions of issued clinical diagnoses among those fulfilling criteria, proportions of patients with significant albuminuria receiving prescribed nephroprotective medications, proportions of accepted referrals to nephrologist care among those fulfilling criteria and proportion of referrals for ultrasound of the kidneys. Discussion Prior pragmatic trials of CDS-systems in CKD has shown an improvement in quality indicators primarily in patients already diagnosed with CKD. This study expands this evidence by focusing on the process of screening, identification, monitoring and diagnostic work-up. Conclusion This pragmatic trial will assess the value of CDS for improved adherence to CKD guidelines in primary care. Clinicaltrials.gov registration: NCT06386172, submitted 2024-04-23.https://doi.org/10.1186/s12882-024-03852-zChronic kidney diseaseClinical decision support systemsPractice facilitatorsScreening, monitoring, awareness, management |
| spellingShingle | Jacob Andersson-Emad Arvid Thunholm Stephen Nash Marie Evans Sara Lind af Hageby Johan Ärnlöv Marie Hilderman Martin Forseth Arvid Sjölander Stefan H. Jacobson Juan Jesus Carrero Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care BMC Nephrology Chronic kidney disease Clinical decision support systems Practice facilitators Screening, monitoring, awareness, management |
| title | Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care |
| title_full | Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care |
| title_fullStr | Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care |
| title_full_unstemmed | Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care |
| title_short | Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care |
| title_sort | study protocol of the alma ckd trial an electronic triggering decision support system to improve the detection recognition and management of patients with chronic kidney disease in primary care |
| topic | Chronic kidney disease Clinical decision support systems Practice facilitators Screening, monitoring, awareness, management |
| url | https://doi.org/10.1186/s12882-024-03852-z |
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