Impact of Dialysis Workflow Decision Support on Conformance to KDOQI Guidelines

DESCRIPTION (provided by applicant): KDOQI clinical practice guidelines (CPGs) improve dialysis patient care but their complexity makes them difficult to integrate into the dialysis clinic. Previous technological solutions Electronic medical records, Clinical Decision Support Systems (CDS) have failed because they were not integrated into the clinic workflow. Visonex LLC proposes to build and test (during Phases I and II) an innovative type of dialysis CDS that assists dialysis clinics to consistently conform to CPGs, provides workflow support and improves quality of care. In order to test the innovation, this project will focuses on a selected subset of KDOQI CPGs. Increased adherence to these CPGs is associated with decreased risk of cardiovascular and all-cause mortality. The software's workflow support will assist the clinic in responding faster and more accurately to CPG deviations and ensure completion of the tasks necessary to achieve conformance to CPG recommendations, improving the ability of the clinic to maintain mineral metabolism markers within their recommended ranges. The software will be built during Phase I and undergo functional testing. It will then be tested using de-identified retrospective data from dialysis clinics. The software's results will be compared to those of manual chart reviews of the same data by clinicians. Any differences between clinician and software will be examined and used to refine the software's functionality before phase II. In Phase II the software will be deployed and integrated into actual dialysis clinics in a stepwise manner. Further refinements will be made to increase the CDS's integration into clinic workflow based on information gathered during deployments. Phase II's overall aim is to increase the number of mineral metabolism markers maintained within the KDOQI recommended range for each patient. A supporting aim is to increase the number of CPG recommended tasks the clinic uses. All effects will be measured pre and post software deployment. The post deployment measures will occur after clinical acclimation to the CDS. While the study is not powered to look at mechanisms of improvement, a subset analysis will be performed with the intent of identifying trends, which could lead to future studies. The end of phase II will result in a dialysis CDS that is quickly assimilated into a clinic's workflow and assists in identifying and treating patients according to the recommendations of the CPGs, which are associated with improved health and decreased mortality. PUBLIC HEALTH RELEVANCE Chronic Kidney Disease (CKD) is a public health crisis and dialysis is the most expensive phase of CKD. The proposed project will result in an integrated expert system that assists dialysis clinics in consistently conforming to guidelines, improves control of mineral metabolism, and becomes a tool for improving the quality of care delivered to patients on dialysis. This system will enrich the data set being collected, providing a new and previously unobtainable insight into clinic operations that can be used for future research.