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. 2021 May 24;3(4):565-575.e1.
doi: 10.1016/j.xkme.2021.03.009. eCollection 2021 Jul-Aug.

Integrated Digital Health System Tools to Support Decision Making and Treatment Preparation in CKD: The PREPARE NOW Study

Jamie A Green  1   2 , Patti L Ephraim  3   4 , Felicia Hill-Briggs  5 , Teri Browne  6 , Tara S Strigo  7 , Chelsie L Hauer  8 , Christina Yule  9 , Rebecca A Stametz  8 , Diane Littlewood  10 , Jane F Pendergast  11 , Sarah Peskoe  11 , Jennifer St Clair Russell  7 , Evan Norfolk  1 , Ion D Bucaloiu  12 , Shravan Kethireddy  13 , Daniel Davis  14 , Jeremy dePrisco  8 , Dave Malloy  8 , Sherri Fulmer  15 , Jennifer Martin  16 , Dori Schatell  17 , Navdeep Tangri  18   19 , Amanda Sees  20 , Cory Siegrist  8 , Jeffrey Breed Jr  8 , Jonathan Billet  8 , Matthew Hackenberg  8 , Nrupen A Bhavsar  7 , L Ebony Boulware  7
Affiliations

Integrated Digital Health System Tools to Support Decision Making and Treatment Preparation in CKD: The PREPARE NOW Study

Jamie A Green et al. Kidney Med. .

Abstract

Rationale & objective: Digital health system tools to support shared decision making and preparation for kidney replacement treatments for patients with chronic kidney disease (CKD) are needed.

Study design: Descriptive study of the implementation of digital infrastructure to support a patient-centered health system intervention.

Setting & participants: 4 CKD clinics within a large integrated health system.

Exposure: We developed an integrated suite of digital engagement tools to support patients' shared decision making and preparation for kidney failure treatments. Tools included an automated CKD patient registry and risk prediction algorithm within the electronic health record (EHR) to identify and prioritize patients in need of nurse case management to facilitate shared decision making and preparation for kidney replacement treatments, an electronic patient-facing values clarification tool, a tracking application to document patients' preparation for treatments, and an EHR work flow to broadcast patients' treatment preferences to all health care providers.

Outcomes: Uptake and acceptability.

Analytic approach: Mixed methods.

Results: From July 1, 2017, through June 30, 2018, the CKD registry identified 1,032 patients in 4 nephrology clinics, of whom 243 (24%) were identified as high risk for progressing to kidney failure within 2 years. Kidney Transitions Specialists enrolled 117 (48%) high-risk patients by the end of year 1. The values tool was completed by 30/33 (91%) patients who attended kidney modality education. Nurse case managers used the tracking application for 100% of patients to document 287 planning steps for kidney replacement therapy. Most (87%) high-risk patients had their preferred kidney replacement modality documented and displayed in the EHR. Nurse case managers reported that the tools facilitated their identification of patients needing support and their navigation activities.

Limitations: Single institution, short duration.

Conclusions: Digital health system tools facilitated rapid identification of patients needing shared and informed decision making and their preparation for kidney replacement treatments.

Funding: This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Project Program Award (IHS-1409-20967).

Trial registration: ClinicalTrials.gov NCT02722382.

Keywords: Digital infrastructure; case management; chronic kidney disease; health information technology; shared decision making.

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Figures

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Graphical abstract
Figure 1
Figure 1
Integrated PREPARE NOW digital health system tools. Abbreviation: EHR, electronic health record.
Figure 2
Figure 2
Chronic kidney disease (CKD) registry. Abbreviations: CM, case management; ER, emergency room; GFR, glomerular filtration rate.
Figure 3
Figure 3
Patient values clarification tool.
Figure 4
Figure 4
Kidney Care Transitions Specialist tracking tool. Abbreviations: BS, blood sugar; CKD, chronic kidney disease; CP, chest pain ; DM, diabetes mellitus; ENT, ear nose throat; HCC, hierarchical condition category; N/V, nausea/vomiting; SOB, short of breath.
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