Navigating the Challenges of Chronic Kidney Disease
| Status: | Completed |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease |
| Therapuetic Areas: | Nephrology / Urology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/30/2013 |
| Start Date: | February 2012 |
| End Date: | September 2014 |
| Contact: | Barbara H. Tucky, B.Sc.; MBA |
| Email: | tuckyb@ccf.org |
| Phone: | 216-444-1044 |
The study's purpose is to address the challenges of providing stage-appropriate chronic
kidney disease (CKD) education and care by developing innovative programs using a CKD
Patient Navigator system and an EHR (electronic health record)-based enhanced electronic
communication system specific for a CKD patient and her/his physicians/caregivers. The
investigators plan a randomized controlled trial of these innovations to examine the utility
and effectiveness of these special interventions.
The investigators' CKD registry aids in identifying patients for recruitment for the
randomized control trial. Patients are randomized into one of four groups. The four groups
are: 1) the control group using MyChart; 2) an enhanced personal health record (PHR)
included in MyChart consisting of 35 websites chosen to disseminate CKD stage-specific goals
of care and CKD education; 3) the patient navigator, a lay professional trained in the
specifics of chronic kidney disease navigation with a focus on the needs of their patients
based on the National Kidney Foundation Disease Outcomes Quality Initiative; 4) the patient
navigator combined with the enhanced MyChart.
The investigators hypothesize that a CKD Patient Navigator program will develop a more
prepared, proactive patient-caregiver team than usual care; the enhanced PHR will produce a
more informed, engaged patient than usual care; the CKD Patient Navigator arm and enhanced
PHR will demonstrate a slower rate of decline in eGFR (glomerular filtration rate) than
usual care.
The results of this study will lay the foundation for a larger multi-center national
clinical trial that will build upon the feasibility and knowledge gained from this planning
grant.
The overall goal of this research is to assess the effects of innovative interventions for
CKD on the decline in renal function among patients with CKD stages 3b or 4. First, a CKD
Patient Navigator program was created, adapted from the use of Patient Navigators
successfully in oncology. Second, an enhanced PHR was developed that uses electronic
communication to disseminate CKD stage-specific goals of care and CKD education. Third, a
randomized controlled trial is being conducted using a factorial design to investigate the
clinical impact and cost-effectiveness of the two interventions - a CKD Patient Navigator
and enhanced PHR compared to usual care for CKD Stage 3b/4 patients.
As a conceptual framework for the proposed study, the investigators are using the Chronic
Care Model developed by Edward H. Wagner, M.D., Director of The MacColl Institute for
Healthcare Innovation, Director of The Robert Wood Johnson Foundation national program
"Improving Chronic Illness Care" and Senior Investigator at the Group Health Research
Institute in Seattle. The model emphasizes a synergy between community, the health care
system, technology and personal interactions to achieve optimal functional and clinical
outcomes among people with chronic diseases. It has been adopted by the National Kidney
Disease Education Program (NKDEP) to achieve many of their goals related to kidney disease.
With the help of the CKD registry, the investigators are recruiting patients from outpatient
clinics at main campus and family health centers located in the surrounding Cleveland area.
Patients are being recruited by a trained study coordinator. All patients are informed about
study procedures and the purpose of the research, verbally and in a written informed consent
document, two copies of which must be signed by both the patient and the study coordinator
before enrollment. Upon enrollment, the patients will be provided with a $25 stipend.
The investigators identify from the CKD Registry and recruit eligible patients with CKD
stage 3b (eGFR 30-44 ml/min/1.73 m2) or Stage 4 (eGFR 15-29 ml/min/1.73 m2) who meet the
inclusion/exclusion criteria. The majority of data comes from the EHR derived CKD registry.
The investigators obtain baseline demographic characteristics (age, gender, and race),
comorbidities, and medication use, smoking status at the baseline visit. Further, CKD stage
specific laboratory data will be collected routinely i.e., whether a laboratory parameter
was measured or not and if measured, whether the laboratory measures and blood pressure are
under the target limits. Details about nephrology, vascular access, and transplant referrals
are obtained at baseline visit. The primary outcome of the study will be change in eGFR over
the two-year study period.
Inclusion Criteria:
- Age less than or equal to 18 years
- English speaking
- eGFR 15-45 ml/min
- patients residing in North East Ohio
Exclusion Criteria:
- mentally incompetent
- cancer
- terminal illness
- patients on dialysis
- patients who have had renal transplant.
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