Integrated Digital Health System Tools to Support Decision Making and Treatment Preparation in CKD: The PREPARE NOW...

Area of Science:

• Health Informatics
• Nephrology
• Patient-Centered Care

Background:

• Shared decision-making and preparation for kidney replacement treatments (KRT) are crucial for patients with chronic kidney disease (CKD).
• Existing digital health systems often lack robust tools to support these complex processes.
• There is a need for integrated digital solutions to improve patient engagement and facilitate informed choices regarding KRT.

Purpose of the Study:

• To develop and implement a suite of digital health tools within an integrated health system.
• To support shared decision-making and preparation for KRT in patients with CKD.
• To evaluate the uptake and acceptability of these digital tools.

Main Methods:

• A descriptive study was conducted using mixed methods to evaluate the implementation of digital infrastructure.
• An integrated suite of digital tools was developed, including an EHR-integrated CKD registry, risk prediction algorithm, patient-facing values clarification tool, and treatment preference tracking application.
• The study involved 4 CKD clinics within a large integrated health system.

Main Results:

• The CKD registry identified 1,032 patients, with 243 (24%) identified as high-risk for kidney failure.
• Nurse case managers enrolled 117 high-risk patients, and 91% of patients attending education completed the values tool.
• The system facilitated documentation of 287 planning steps for KRT, with 87% of high-risk patients having their preferences documented in the EHR.

Conclusions:

• Digital health system tools successfully facilitated the rapid identification of patients requiring shared decision-making.
• The implemented tools supported patient preparation for kidney replacement treatments.
• The study highlights the potential of digital health interventions to enhance patient-centered care in CKD management.