RATIONALE & OBJECTIVE Chronic kidney disease affects millions of people in the United States, yet effective interventions to address gaps in patient knowledge and engagement are not well established. We sought to develop and pilot a brief educational decision aid for patients with CKD cared for in primary care settings. STUDY DESIGN A pilot QI study of a decision aid intervention. SETTING & PARTICIPANTS The decision aid was introduced and used in one of two General Internal Medicine primary care clinics for adult patients with chronic kidney disease. QUALITY IMPROVEMENT ACTIVITIES Using QI methods, an EMR-based patient educational decision aid called the Encounter Decision Intervention (EDI) was developed with input from patients and clinicians for use during primary care visits to address a CKD diagnosis and engage patients in their clinical management. OUTCOMES Outcomes were assessed using validated surveys of perceived and objective CKD knowledge, CKD-specific stress and patient satisfaction were measured in both primary care clinics. ANALYTICAL APPROACH Fisher exact tests, t-tests, and Kruskal-Wallis tests were used to detect univariable associations of outcomes with use of the EDI across primary care clinics. RESULTS Seventy-four patients completed the study (37 in each clinic). There were no statistically significant differences in patient characteristics between clinics. The group treated in the clinic using the EDI had statistically significantly higher satisfaction with clinician communication, overall care, and with their clinicians. Patients reported high satisfaction with the EDI and clinicians reported favorable usability. LIMITATIONS A non-randomized comparison, small sample size, possible differences across practice settings. CONCLUSION A new integrated educational decision aid was successfully implemented in a primary care setting. Pilot testing suggested that the EDI was associated with higher patient satisfaction with clinician communication, overall care, and with their primary care provider.

中文翻译：

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CKD 的患者教育和初级保健中的决策支持：EPIK 试点研究的结果。


基本原理和目标 慢性肾病影响了美国的数百万人，但解决患者知识和参与度差距的有效干预措施并未得到充分确立。我们试图为在初级保健机构接受护理的 CKD 患者开发和试行一种简短的教育决策辅助工具。研究设计 决策辅助干预的试点 QI 研究。设置和参与者 决策辅助工具被引入并在两个普通内科初级保健诊所的其中一所用于成年慢性肾病患者。质量改进活动 使用 QI 方法，根据患者和临床医生的意见开发了一种基于 EMR 的患者教育决策辅助工具，称为 Encounter Decision Intervention （EDI），用于初级保健就诊，以解决 CKD 诊断并让患者参与临床管理。结果 使用对感知和客观 CKD 知识的有效调查评估结果，在两个初级保健诊所测量 CKD 特异性压力和患者满意度。分析方法 使用 Fisher 精确检验、t 检验和 Kruskal-Wallis 检验来检测初级保健诊所使用 EDI 的结果的单变量关联。结果 74 例患者完成了研究 （每个诊所 37 例）。诊所之间患者特征无统计学意义差异。使用 EDI 在诊所治疗的组对临床医生沟通、整体护理和临床医生的满意度在统计学上显着更高。患者报告对 EDI 非常满意，临床医生报告良好的可用性。局限性 非随机比较，样本量小，不同实践环境之间可能存在差异。 结论 一种新的综合教育决策辅助工具在初级保健环境中成功实施。试点测试表明，EDI 与患者对临床医生沟通、整体护理和初级保健提供者的满意度较高相关。