Does underrecognition of kidney disease affect patient safety?

Summary

Principal Investigator: J C Fink
Affiliation: University of Maryland
Country: USA
Abstract: DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) is common, but under-recognized, in the health care system, where improving patient safety is a high priority. Poor disease recognition and several other features of CKD make it a high risk condition for adverse safety events. These adverse safety events may include those usually cited for the general population, but also, disease-specific unsafe practices and errors, which in turn, can lead to adverse disease endpoints. Hypothesis: an intervention designed to increase recognition of CKD (a structural measure) will reduce adverse events (outcome measures) by a decrease in the frequency of unsafe medical practices and errors (process measures). Overall aims: 1) We will establish disease-specific process measures reflecting patient safety in CKD (CKD-PSIs) and then measure them in a CKD validation cohort, which will be tracked longitudinally]. 2) [We will evaluate an intervention designed to improve recognition of CKD in a pilot study of CKD patients]. Intervention: An alert system comprised of a CKD med-alert bracelet (or necklace) with a web-based informational link describing the safe care of patients with kidney disease. Study design: a) A consensus-based process intended to establish a set of CKD-PSI linked to disease- specific patient safety, [b) a cohort study of persons with CKD to validate the use of the CKD-PSIs, c) a pilot study of persons with CKD to determine the acceptance and impact of the alert system with longitudinal follow- up to identify preliminary evidence of the efficacy of the intervention on the incidence of CKD-PSIs . Study population: Persons with Stage III - V, pre-dialysis CKD enrolled from a single center with two associated hospitals [validation cohort study: n = 250, pilot study = 100]. Study Measurements: Participants [in both the validation cohort and pilot sample] will undergo baseline and annual in-center visits for medical history and medication review, measurement of renal function (serum Cr for estimation of GFR), follow-up telephone calls [every 4 months between visits] for medical events, and review of hospitalizations (expected duration: from 1 to 3 annual follow-up visits). [Pilot study participants will undergo critical incident surveys at 1 year.] Outcomes: a) [CKD-PSIs (process measures) expected to] include medication errors (e.g., NSAIDs, improperly dosed meds), toxic exposures (e.g., contrast agents, etc), and medical events (e.g., hyperkalemia or hypoglycemia, etc);b) outcome measures including changing renal function, hospitalization, ESRD, and death will also be tracked;c) [acceptance of Med-alert intervention] . Expected findings: Endorsed CKD-PSIs will be feasibly measured and detectable at a significant baseline rate. These CKD-PSIs will show evidence of association with subsequent adverse renal outcomes. The alert intervention will be well tolerated over time and demonstrate indications of a positive impact on the safety of care of patients with CKD. The findings from this study will be instrumental to the development of a randomized controlled trial testing whether increased disease recognition will reduce adverse disease outcomes in CKD via improved patient safety]. PUBLIC HEALTH RELEVANCE: Chronic kidney disease (CKD) is common, and often goes unrecognized among patients using the health care system where improving patient safety has become a high priority. We will validate the use CKD-specific patient safety indicators and pilot the use of a Medi-alert bracelet and necklace to increase the recognition of CKD, and evaluate its efficacy in reducing the frequency of CKD-specific safety events.
Funding Period: ----------------2010 - ---------------2015-
more information: NIH RePORT

Top Publications

  1. pmc Usability of a CKD educational website targeted to patients and their family members
    Clarissa J Diamantidis
    Division of Nephrology and Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
    Clin J Am Soc Nephrol 7:1553-60. 2012
  2. pmc Consideration of ICD-9 Code-Derived Disease-Specific Safety Indicators in CKD
    Iris R Hartley
    Departments of Medicine and, Epidemiology and Public Health, School of Medicine and, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, Fairleigh Dickinson University, Pharmacy Practice Division, School of Pharmacy, Florham Park, New Jersey
    Clin J Am Soc Nephrol 8:2123-31. 2013
  3. pmc Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study
    Clarissa Jonas Diamantidis
    Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, United States
    J Med Internet Res 15:e251. 2013
  4. pmc Patient-Reported and Actionable Safety Events in CKD
    Jennifer S Ginsberg
    Department of Medicine and
    J Am Soc Nephrol 25:1564-73. 2014
  5. ncbi Safety of medical therapy in patients with chronic kidney disease and end-stage renal disease
    Matthew R Weir
    Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
    Curr Opin Nephrol Hypertens 23:306-13. 2014

Detail Information

Publications5

  1. pmc Usability of a CKD educational website targeted to patients and their family members
    Clarissa J Diamantidis
    Division of Nephrology and Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
    Clin J Am Soc Nephrol 7:1553-60. 2012
    ..safekidneycare.org), an informational website on safety in CKD...
  2. pmc Consideration of ICD-9 Code-Derived Disease-Specific Safety Indicators in CKD
    Iris R Hartley
    Departments of Medicine and, Epidemiology and Public Health, School of Medicine and, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, Fairleigh Dickinson University, Pharmacy Practice Division, School of Pharmacy, Florham Park, New Jersey
    Clin J Am Soc Nephrol 8:2123-31. 2013
    ..This study considers candidate CKD-pertinent patient safety indicators and compares them with the Agency for Healthcare and Research Quality patient safety indicators...
  3. pmc Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study
    Clarissa Jonas Diamantidis
    Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, United States
    J Med Internet Res 15:e251. 2013
    ..Health information technology has become common in the care of patients with chronic diseases; however, there are few such applications employed in kidney disease...
  4. pmc Patient-Reported and Actionable Safety Events in CKD
    Jennifer S Ginsberg
    Department of Medicine and
    J Am Soc Nephrol 25:1564-73. 2014
    ..Further work is needed to define the CKD "safety phenotype" and identify patients at highest risk for adverse safety events. ..
  5. ncbi Safety of medical therapy in patients with chronic kidney disease and end-stage renal disease
    Matthew R Weir
    Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
    Curr Opin Nephrol Hypertens 23:306-13. 2014
    ..Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have an increased frequency of adverse safety events largely because of medication errors...