Electronic health record algorithm did not reduce hospitalizations in patients with CKD
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Key takeaways:
- Hospitalization rates at 1 year were 20.7% in the intervention group and 21.1% for usual care.
- Risk of ED visits, readmissions and death were similar in both groups.
Using an electronic health record algorithm and practice facilitators in primary care did not reduce hospitalizations in adults with chronic kidney disease, type 2 diabetes and hypertension, according to results of a study.
It has become more common for patients to have “multiple chronic conditions, which has led to an increase in mortality, preventable hospitalizations and health care costs, as well as more emergency department visits,” Miguel A. Vazquez, MD, of the department of internal medicine at the University of Texas Southwestern Medical Center, and researchers wrote. Despite available therapies for patients with these three chronic conditions, the “results of large-scale trials examining the implementation of guideline-directed therapy to reduce the risk of death and complications in this population are lacking.”
Researchers conducted an open-label, cluster-randomized study, which included 11,182 patients (aged 18 to 85 years) from 141 primary care clinics who received either a personalized algorithm intervention or usual care. Investigators assigned 71 practices (enrolling 5,690 patients) to the intervention group and 70 practices (5,492 patients) to usual care for the pragmatic trial.
CKD was defined as an eGFR lower than 60 mL/min/1.73 m2. Type 2 diabetes and hypertension were defined as documentation in the problem list of the EHR or any one of a list of qualifying medical factors.
The goal was to identify patients and practice facilitators to assist providers in delivering guideline-based interventions. Main outcome was hospitalization for any cause at 1 year.
Hospitalization rates at 1 year were 20.7% in the intervention group and 21.1% in the usual-care group, according to the study results. The risks of ED visits, readmissions, cardiovascular events, dialysis and death were also similar in both groups.
The risk of adverse events was also similar in the trial groups, except for AKI, which was higher in the intervention group compared with the usual-care group (12.7% vs. 11.3%).
“Our trial provides important lessons for future embedded pragmatic clinical trials that are designed to test the delivery of multicomponent interventions in patients with multiple chronic diseases,” Vazquez and colleagues wrote.
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