{"doi":"10.1001/jamainternmed.2024.0708","title":"Electronic Health Record Population Health Management for Chronic Kidney Disease Care","abstract":"<jats:sec><jats:title>Importance</jats:title><jats:p>Large gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To compare the effectiveness of an electronic health record–based population health management intervention vs usual care for reducing CKD progression and improving evidence-based care in high-risk CKD.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>The Kidney Coordinated Health Management Partnership (Kidney CHAMP) was a pragmatic cluster randomized clinical trial conducted between May 2019 and July 2022 in 101 primary care practices in Western Pennsylvania. It included patients aged 18 to 85 years with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m<jats:sup>2</jats:sup> with high risk of CKD progression and no outpatient nephrology encounter within the previous 12 months.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Multifaceted intervention for CKD comanagement with primary care clinicians included a nephrology electronic consultation, pharmacist-led medication management, and CKD education for patients. The usual care group received CKD care from primary care clinicians as usual.</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>The primary outcome was time to 40% or greater reduction in eGFR or end-stage kidney disease.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 1596 patients (754 intervention [47.2%]; 842 control [52.8%]) with a mean (SD) age of 74 (9) years, 928 (58%) were female, 127 (8%) were Black, 9 (0.6%) were Hispanic, and the mean (SD) estimated glomerular filtration rate was 36.8 (7.9) mL/min/1.73m<jats:sup>2</jats:sup>. Over a median follow-up of 17.0 months, there was no significant difference in rate of primary outcome between the 2 arms (adjusted hazard ratio, 0.96; 95% CI, 0.67-1.38; <jats:italic>P</jats:italic> = .82). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker exposure was more frequent in intervention arm compared with the control group (rate ratio, 1.21; 95% CI, 1.02-1.43). There was no difference in the secondary outcomes of hypertension control and exposure to unsafe medications or adverse events between the arms. Several COVID-19–related issues contributed to null findings in the study.</jats:p></jats:sec><jats:sec><jats:title>Conclusion and Relevance</jats:title><jats:p>In this study, among patients with moderate-risk to high-risk CKD, a multifaceted electronic health record–based population health management intervention resulted in more exposure days to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers but did not reduce risk of CKD progression or hypertension control vs usual care.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.clinicaltrials.gov/study/NCT03832595\">NCT03832595</jats:ext-link></jats:p></jats:sec>","journal":"JAMA Internal Medicine","year":2024,"id":628924,"datarank":0.5676284450877392,"base_score":3.784189633918261,"endowment":3.784189633918261,"self_citation_contribution":0.5676284450877392,"citation_network_contribution":0.0,"self_endowment_contribution":0.5676284450877392,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":43,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1079888,"name":"Melanie R. Weltman","orcid":"0000-0003-2232-0454","position":1,"is_corresponding":false},{"id":492487,"name":"Susan M. Devaraj","orcid":"0000-0002-3702-2874","position":2,"is_corresponding":false},{"id":1101262,"name":"Linda-Marie Ustaris Lavenburg","orcid":"0000-0001-8813-7017","position":3,"is_corresponding":false},{"id":1390642,"name":"Zhuoheng Han","orcid":"0009-0006-9506-9837","position":4,"is_corresponding":false},{"id":1390643,"name":"Alaa A. Alghwiri","orcid":"0009-0006-4815-5652","position":5,"is_corresponding":false},{"id":451541,"name":"Gary S. Fischer","orcid":"0000-0001-7671-207X","position":6,"is_corresponding":false},{"id":732294,"name":"Bruce L. Rollman","orcid":"0000-0002-2937-7464","position":7,"is_corresponding":false},{"id":363543,"name":"Thomas D. Nolin","orcid":"0000-0003-4339-1382","position":8,"is_corresponding":false},{"id":153514,"name":"Jonathan G. Yabes","orcid":null,"position":9,"is_corresponding":false},{"id":773595,"name":"Manisha Jhamb","orcid":"0000-0002-9178-1468","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Electronic Health Record Population Health Management for Chronic Kidney Disease Care","abstract":"<jats:sec><jats:title>Importance</jats:title><jats:p>Large gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To compare the effectiveness of an electronic health record–based population health management intervention vs usual care for reducing CKD progression and improving evidence-based care in high-risk CKD.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>The Kidney Coordinated Health Management Partnership (Kidney CHAMP) was a pragmatic cluster randomized clinical trial conducted between May 2019 and July 2022 in 101 primary care practices in Western Pennsylvania. It included patients aged 18 to 85 years with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m<jats:sup>2</jats:sup> with high risk of CKD progression and no outpatient nephrology encounter within the previous 12 months.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Multifaceted intervention for CKD comanagement with primary care clinicians included a nephrology electronic consultation, pharmacist-led medication management, and CKD education for patients. The usual care group received CKD care from primary care clinicians as usual.</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>The primary outcome was time to 40% or greater reduction in eGFR or end-stage kidney disease.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 1596 patients (754 intervention [47.2%]; 842 control [52.8%]) with a mean (SD) age of 74 (9) years, 928 (58%) were female, 127 (8%) were Black, 9 (0.6%) were Hispanic, and the mean (SD) estimated glomerular filtration rate was 36.8 (7.9) mL/min/1.73m<jats:sup>2</jats:sup>. Over a median follow-up of 17.0 months, there was no significant difference in rate of primary outcome between the 2 arms (adjusted hazard ratio, 0.96; 95% CI, 0.67-1.38; <jats:italic>P</jats:italic> = .82). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker exposure was more frequent in intervention arm compared with the control group (rate ratio, 1.21; 95% CI, 1.02-1.43). There was no difference in the secondary outcomes of hypertension control and exposure to unsafe medications or adverse events between the arms. Several COVID-19–related issues contributed to null findings in the study.</jats:p></jats:sec><jats:sec><jats:title>Conclusion and Relevance</jats:title><jats:p>In this study, among patients with moderate-risk to high-risk CKD, a multifaceted electronic health record–based population health management intervention resulted in more exposure days to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers but did not reduce risk of CKD progression or hypertension control vs usual care.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.clinicaltrials.gov/study/NCT03832595\">NCT03832595</jats:ext-link></jats:p></jats:sec>","is_dataset_classified":null,"base_score":3.713572066704308,"endowment":3.713572066704308,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"38619824","pmcid":"PMC11019443","openalex_id":"https://openalex.org/W4394807313","authors":[],"funders":[{"funder_name":"NIDDK NIH HHS","grant_id":"R01 DK116957","title":null},{"funder_name":"National Institutes of Health","grant_id":"5R01DK116957-05","title":"PopulAtioN health management to OPTImize Care in CKD (PANOPTIC-CKD)"},{"funder_name":"National Institutes of Health","grant_id":"5T32DK061296-04","title":"Renal and Epithelial Biology Training Program"},{"funder_name":"National Institutes of Health","grant_id":"5T32HL110849-12","title":"Training in Translational Research in Pulmonary Vascular Biology"}],"total_grants":4,"fwci":9.6447,"citation_percentile":0.98866392,"influential_citations":0,"citation_trend":[{"year":2024,"count":6},{"year":2025,"count":18},{"year":2026,"count":16}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2817606/jamainternal_jhamb_2024_oi_240016_1719497542.46116.pdf","host_type":"journal"},{"url":"https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2817606/jamainternal_jhamb_2024_oi_240016_1719497542.46116.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1001/jamainternmed.2024.0708","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/38619824","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11019443","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11019443","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.1001/jamainternmed.2024.0708","host_type":""}],"fields_of_study":["Chronic Kidney Disease and Diabetes","Chronic Disease Management Strategies","Diabetes Treatment and Management","03 medical and health sciences","0302 clinical medicine"],"mesh_terms":["Population Health Management","Adult","Aged","Aged, 80 and over","Female","Glomerular Filtration Rate","Humans","Male","Middle Aged","Primary Health Care","Disease Progression","Renal Insufficiency, Chronic","Electronic Health Records"],"keywords":["Medicine","Kidney disease","Nephrology","Internal medicine","Population","Renal function","Randomized controlled trial","Ambulatory care","Psychological intervention","Health care","Physical therapy","Intensive care medicine","Nursing","Adult","Aged, 80 and over","Male","Primary Health Care","Middle Aged","Disease Progression","Humans","Electronic Health Records","Population Health Management","Female","Renal Insufficiency, Chronic","Original Investigation","Aged","Glomerular Filtration Rate"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[{"name":"nct"},{"name":"doi"}],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-05T15:36:28.174601Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}