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Recommendations for a Clinical Decision Support for the Management of Individuals with Chronic Kidney Disease

Meenal B. Patwardhan^*,,, Kensaku Kawamoto^,||, David Lobach, Uptal D. Patel^¶, and David B. Matchar^*,,**,

^* Duke Center for Clinical Health Policy Research, Durham, North Carolina; Abbott Laboratories, Abbott Park, Illinois; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center; Division of Clinical Informatics, Department of Community and Family Medicine, Duke University Medical Center; ^|| Institute for Genome Sciences & Policy, Duke University, Durham, North Carolina; ^¶ Division of Nephrology, Department of Medicine, Duke University Medical Center; ^** Veterans Administration Health Services Research; Veterans Administration Medical Center, Durham, North Carolina

Correspondence: Dr. Meenal B. Patwardhan, Duke Center for Clinical Health Policy Research, 2200 W. Main Street, Suite 220 Durham NC 27705. Phone: 919-286-3399; Fax: 919-286-5601; E-mail: Meenal.P{at}Duke.edu

Background and objectives: Care for advanced CKD patients is suboptimal. CKD practice guidelines aim to close gaps in care, but making providers aware of guidelines is an ineffective implementation strategy. The Institute of Medicine has endorsed the use of clinical decision support (CDS) for implementing guidelines. The authors’ objective was to identify the requirements of an optimal CDS system for CKD management.

Design, setting, participants, and measurements: The aims of this study expanded on those of previous work that used the facilitated process improvement (FPI) methodology. In FPI, an expert workgroup develops a set of quality improvement tools that can subsequently be utilized by practicing physicians. The authors conducted a discussion with a group of multidisciplinary experts to identify requirements for an optimal CDS system.

Results: The panel considered the process of patient identification and management, associated barriers, and elements by which CDS could address these barriers. The panel also discussed specific knowledge needs in the context of a typical scenario in which CDS would be used. Finally, the group developed a set of core requirements that will likely facilitate the implementation of a CDS system aimed at improving the management of any chronic medical condition.

Conclusions: Considering the growing burden of CKD and the potential healthcare and resource impact of guideline implementation through CDS, the relevance of this systematic process, consistent with Institute of Medicine recommendations, cannot be understated. The requirements described in this report could serve as a basis for the design of a CKD-specific CDS.