Clinical decision support to improve blood pressure control in hemodialysis patients: a nonrandomized controlled trial
| Autor: | Stephanie Thompson, Brenda Hemmelgarn, Natasha Wiebe, Sumit Majumdar, Scott Klarenbach, Kailash Jindal, Braden Manns, Garth Mortis, Patricia Campbell, Marcello Tonelli, null Alberta Kidney Disease Network |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Systole medicine.medical_treatment Population Blood Pressure Alberta Decision Support Techniques law.invention Randomized controlled trial Predictive Value of Tests Renal Dialysis Risk Factors law Internal medicine Odds Ratio Prevalence Humans Medicine Practice Patterns Physicians' Renal Insufficiency Chronic education Antihypertensive Agents Dialysis Aged education.field_of_study business.industry Blood Pressure Determination Odds ratio Middle Aged Confidence interval Drug Therapy Computer-Assisted Treatment Outcome Blood pressure Nephrology Predictive value of tests Hypertension Practice Guidelines as Topic Physical therapy Decision Support Systems Management Female Guideline Adherence Hemodialysis business |
| Zdroj: | Journal of Nephrology. 25:944-953 |
| ISSN: | 1121-8428 |
| DOI: | 10.5301/jn.5000238 |
| Popis: | Background Computer-based clinical decision support aims to improve the quality of patient care. The utility of decision support for improving blood pressure control in hemodialysis patients is unknown. Methods This was a nonrandomized controlled trial of adult patients receiving chronic in-center hemodialysis during the period of April 1, 2005, to September 30, 2006, in 1 of the 2 major university-based renal programs in Alberta, Canada. Physicians in the intervention center were provided with twice-monthly audits and printed management suggestions based on guideline-recommended blood pressure targets. The same data were available to physicians in the control group but without audit and feedback decision support. Results Eight hundred and thirty hemodialysis patients were receiving dialysis treatment at the time the study was initiated. Preintervention and postintervention blood pressure data were available for 361 patients. The primary outcome, the proportion of postdialysis systolic blood pressures at target over 12 months, did not differ between the intervention and the control programs (unadjusted odds ratio 0.59; 95% confidence interval [95% CI], 0.34-1.02, p = 0.06; adjusted odds ratio 0.62; 95% CI, 0.35-1.11, p = 0.11). There was no significant difference between the intervention and control groups in other measures of blood pressure such as the mean change in postdialysis systolic blood pressures (unadjusted mean difference 4 mm Hg, 95% CI, -1 to 9, p = 0.36; adjusted mean difference 2 mm Hg, 95% CI, -1 to 5, p = 0.19). Conclusions In this population of chronic hemodialysis patients, a computer-based clinical decision support system was not associated with improved blood pressure control. |
| Databáze: | OpenAIRE |
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