Study: Intervention using electronic health records did not slow progression of CKD
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Key takeaways:
- Use of electronic health records to help direct treatment of chronic kidney disease did not help slow progression.
- The study authors wrote that the intervention can still benefit patients.
Use of an electronic health record-based intervention among patients with chronic kidney disease led to greater use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers but did not slow progression of the disease.
“Despite the null result, we found that the Kidney-[Coordinated Health Management Partnership] CHAMP framework is scalable, provides equitable access and overcomes barriers on the provider, patient and health system levels,” Manisha Jhamb, MD, MPH, associate chief of the renal-electrolyte division at the University of Pittsburgh School of Medicine (UPMC), said in a press release. “The big positive is that we were able to implement this in more than 100 practices across a large geographic area that included many rural communities in the midst of a global pandemic.” Jhamb received a $3.5 million grant from the NIH to conduct the study.
Using EHRs, researchers enrolled 1,317 patients aged 18 to 85 years from primary care practices between May 2019 and July 2022. Patients had a baseline eGFR of less than 60 mL/min/1.73m2, high risk of CKD progression and no outpatient nephrology encounter within the previous 12 months. “The primary outcome was time to 40% or greater reduction in eGFR or end-stage kidney disease,” the researchers wrote. Mean follow-up was 17 months.
After the patient group was identified using the EHR intervention, a multidisciplinary team reviewed the cases. “Multifaceted intervention for CKD co-management with primary care clinicians included a nephrology electronic consultation, pharmacist-led medication management, and CKD education for patients,” the researchers wrote. “The usual care group received CKD care from primary care clinicians as usual.”
During the next appointment, real-time reminders prompted the physician to review recommendations and place or change medication orders. Those interventions, however, did not lead to a slowing of CKD progression, the researchers wrote.
“Over a median follow-up of 17 months, there was no significant difference in rate of primary outcome between the [two] arms (adjusted HR 0.96; 95% CI, 0.67-1.38; P = .82). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker exposure was more frequent in intervention arm compared with the control group (rate ratio, 1.21; 95% CI, 1.02-1.43). There was no difference in the secondary outcomes of hypertension control and exposure to unsafe medications or adverse events between the arms,” the authors wrote. “Several COVID-19–related issues contributed to null findings in the study.”
As a result of the study, Kidney-CHAMP formed a partnership with the UPMC Health Plan and has rolled out the partnership to more than 2,500 patients.
“Although Kidney-CHAMP neither helped nor hurt patient outcomes compared to those who received regular care, patients in the program were more likely to receive appropriate medications and very few physician practices opted out of the intervention,” according to the release.
In a published commentary about the study, Yasaman Yazdani, MD, and colleagues wrote that the Kidney-CHAMP trial was “an exemplary use of an EHR system to facilitate eligible patient identification, recruitment, risk assessment and collection of outcome data to deliver and evaluate a CKD intervention” and should be considered “as a landmark on the way to a learning health system in which low-cost evaluations are seamlessly built into the implementation of every major innovation or change in care delivery.”
But the intervention did not improve management of CKD, the authors wrote, because “the impetus for care improvement and the design of the interventions originated with specialist nephrologists but was aimed at changing PCP behavior.”
They added, “While the intervention had good face validity and its delivery of the nephrology and pharmacist consultations to PCPs was reliable, it did not overcome barriers to PCP and patient behavior change sufficiently to achieve its declared primary outcome.”
Reference:
Yazdani Y, et al. JAMA Intern Med.2024;doi:10.1001/jamainternmed.2024.0873. Accessed April 17, 2024.
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