# Electronic Tools to Increase Recognition and Improve Primary Care Management for Hypertension in Chronic Kidney Disease

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2022 · $250,528

## Abstract

The greatest opportunity to improve the length and quality of life for patients with chronic kidney disease (CKD)
is to identify and intervene early on the chronic conditions that contribute to CKD progression and poor
outcomes. Although both CKD and hypertension (HTN), the main risk factor for CKD progression, are not
difficult to diagnose, both often go unrecognized by PCPs. Since patients with CKD generally receive their care
from primary care physicians (PCPs), primary care-based interventions have the greatest potential to improve
health for CKD patients. Electronic health records (EHRs) present an innovative delivery approach to improve
CKD management in primary care. However, the impact of EHRs, registries and clinical decision support
(CDS) has been modest in CKD. Hypothesis: The mean systolic blood pressure of the CKD population can be
decreased by an intervention with three innovative features: 1) methods to synthesize EHR data in order to
identify under-diagnosed chronic conditions, 2) iterative improvement in CDS content through human factors
methods to maximize the “informativeness” of the CDS, and 3) the use of behavioral economic principles to
create behavioral “nudges” internal and external to the CDS. Specific Aim 1: To develop and validate the
intervention. Specific Aim 1a: To develop and validate the CDS that will: 1) synthesize existing laboratory
tests, medication orders, and vital sign data; 2) increase recognition of CKD, 3) increase recognition of
uncontrolled HTN in CKD patients; and 4) deliver evidence-based CKD and HTN management
recommendations. The validation will consist of an 8-week silent run-in period and chart review. Specific Aim
1b: To improve the “informativeness” of the content of the CDS using human factors methods, specifically by
conducting a “think-aloud” study. Specific Aim 1c: To develop a “wrap-around” intervention including three
behavioral “nudges”: 1) pre-checked default orders, 2) an in-person conference with PCPs to obtain their
commitment to follow the CDS recommendations, and 3) a required “accountable justification” if the PCP does
not follow the CDS recommendations. Specific Aim 2: To test the effectiveness of the intervention. Specific
Aim 2a: To evaluate whether the intervention developed in Aim 1 significantly decreases mean systolic blood
pressure in a population of CKD patients with blood pressure > 140/90, N=2,350 (N derived from EHR data
about primary care patients at 15 clinics). We will evaluate the effectiveness of the intervention in a pragmatic,
cluster-randomized controlled trial, randomized at the level of the physician (180 PCPs). Secondary outcomes
will include hypertension-specific process measures, such as treatment intensification. Specific Aim 2b: To
evaluate whether the intervention improves process measures for quality of CKD care including: documented
CKD diagnosis, annual serum creatinine test, and annual urine albumin test. Specific Aim 2c: To perform a
cross-over stud...

## Key facts

- **NIH application ID:** 10689403
- **Project number:** 3R01DK116898-05S1
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Lipika Samal
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $250,528
- **Award type:** 3
- **Project period:** 2018-09-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10689403

## Citation

> US National Institutes of Health, RePORTER application 10689403, Electronic Tools to Increase Recognition and Improve Primary Care Management for Hypertension in Chronic Kidney Disease (3R01DK116898-05S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10689403. Licensed CC0.

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