Trial Outcomes & Findings for Electronic Patient-Reported Outcomes in Clinical Kidney Practice (ePRO Kidney) (NCT NCT03149328)

NCT ID: NCT03149328

Last Updated: 2021-10-05

Results Overview

Assessed using the symptoms/problems domain of the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36). The Symptoms/Problems domain has 12 items, each representing a symptom or side effect of kidney disease based on the past 4 weeks with 5 response items ranging from "Not Bothered at all = 100" to "Extremely Bothered = 0". Min Score = 0; Max score = 100. Higher score indicates better health.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

594 participants

Primary outcome timeframe

Trajectories of up to 24 months from start of enrollment to study completion

Results posted on

2021-10-05

Participant Flow

Patients who attended a home dialysis clinic in either the Aberhart Center in Edmonton (NARP), between August 28, 2017 \& August 30, 2019 or the Sheldon M Chumir Health Center in Calgary (SARP), between October 5, 2017 \& October 31, 2019 and who met the inclusion criteria were invited to participate in this study. Patients were excluded if they were under 18 years of age, could not read or speak English or could not provide informed consent.

Patients were recruited and placed into their arm based on the clinic they were attending - there was no random assignment. 51 participants were clinicians (48) and family caregivers (3), these 2 participants groups were not part of the trial portion of the study.

Participant milestones

Participant milestones
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Overall Study
STARTED
284
259
Overall Study
COMPLETED
200
213
Overall Study
NOT COMPLETED
84
46

Reasons for withdrawal

Reasons for withdrawal
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Overall Study
Withdrawal by Subject
30
26
Overall Study
Changed Dialysis Modality
18
1
Overall Study
Transplant
9
1
Overall Study
Lost to Follow-up
25
16
Overall Study
Left Study Site
1
2
Overall Study
Language Barrier
1
0

Baseline Characteristics

2 participants chose not to answer - missing data

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
n=284 Participants
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
n=259 Participants
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinciains did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Total
n=543 Participants
Total of all reporting groups
Age, Continuous
55.4 years
STANDARD_DEVIATION 13.3 • n=282 Participants • 2 participants chose not to answer - missing data
56.7 years
STANDARD_DEVIATION 14.2 • n=259 Participants • 2 participants chose not to answer - missing data
56.0 years
STANDARD_DEVIATION 13.8 • n=541 Participants • 2 participants chose not to answer - missing data
Sex: Female, Male
Female
97 Participants
n=282 Participants • 2 participants chose to not answer - missing data
88 Participants
n=259 Participants • 2 participants chose to not answer - missing data
185 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Sex: Female, Male
Male
185 Participants
n=282 Participants • 2 participants chose to not answer - missing data
171 Participants
n=259 Participants • 2 participants chose to not answer - missing data
356 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Race/Ethnicity, Customized
Race/Ethnicity · Aboriginal
23 Participants
n=284 Participants
9 Participants
n=259 Participants
32 Participants
n=543 Participants
Race/Ethnicity, Customized
Race/Ethnicity · Asian
42 Participants
n=284 Participants
62 Participants
n=259 Participants
104 Participants
n=543 Participants
Race/Ethnicity, Customized
Race/Ethnicity · White
196 Participants
n=284 Participants
159 Participants
n=259 Participants
355 Participants
n=543 Participants
Race/Ethnicity, Customized
Race/Ethnicity · Black
4 Participants
n=284 Participants
10 Participants
n=259 Participants
14 Participants
n=543 Participants
Race/Ethnicity, Customized
Race/Ethnicity · Other
14 Participants
n=284 Participants
6 Participants
n=259 Participants
20 Participants
n=543 Participants
Race/Ethnicity, Customized
Race/Ethnicity · More than one race/ethnicity
5 Participants
n=284 Participants
12 Participants
n=259 Participants
17 Participants
n=543 Participants
Race/Ethnicity, Customized
Race/Ethnicity · Unknown or not reported
0 Participants
n=284 Participants
1 Participants
n=259 Participants
1 Participants
n=543 Participants
Employment Status
Retired
77 Participants
n=283 Participants • 2 participants chose to not answer - missing data
95 Participants
n=258 Participants • 2 participants chose to not answer - missing data
172 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Employment Status
Unable to Work
82 Participants
n=283 Participants • 2 participants chose to not answer - missing data
61 Participants
n=258 Participants • 2 participants chose to not answer - missing data
143 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Employment Status
Working
89 Participants
n=283 Participants • 2 participants chose to not answer - missing data
76 Participants
n=258 Participants • 2 participants chose to not answer - missing data
165 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Employment Status
Other
35 Participants
n=283 Participants • 2 participants chose to not answer - missing data
26 Participants
n=258 Participants • 2 participants chose to not answer - missing data
61 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Highlest Level of Education
Elementary School
18 Participants
n=284 Participants • 2 participants chose to not answer - missing data
5 Participants
n=257 Participants • 2 participants chose to not answer - missing data
23 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Highlest Level of Education
High School Graduate
95 Participants
n=284 Participants • 2 participants chose to not answer - missing data
67 Participants
n=257 Participants • 2 participants chose to not answer - missing data
162 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Highlest Level of Education
College / Trade Diploma
101 Participants
n=284 Participants • 2 participants chose to not answer - missing data
113 Participants
n=257 Participants • 2 participants chose to not answer - missing data
214 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Highlest Level of Education
Undergraduate Degree
40 Participants
n=284 Participants • 2 participants chose to not answer - missing data
50 Participants
n=257 Participants • 2 participants chose to not answer - missing data
90 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Highlest Level of Education
Graduate Degree
25 Participants
n=284 Participants • 2 participants chose to not answer - missing data
18 Participants
n=257 Participants • 2 participants chose to not answer - missing data
43 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Highlest Level of Education
Other
5 Participants
n=284 Participants • 2 participants chose to not answer - missing data
4 Participants
n=257 Participants • 2 participants chose to not answer - missing data
9 Participants
n=541 Participants • 2 participants chose to not answer - missing data
Type of Dialysis
Peritoneal
199 Participants
n=282 Participants • 2 participants chose not to answer - missing data
187 Participants
n=259 Participants • 2 participants chose not to answer - missing data
386 Participants
n=541 Participants • 2 participants chose not to answer - missing data
Type of Dialysis
Home Hemodialysis
75 Participants
n=282 Participants • 2 participants chose not to answer - missing data
65 Participants
n=259 Participants • 2 participants chose not to answer - missing data
140 Participants
n=541 Participants • 2 participants chose not to answer - missing data
Type of Dialysis
Nocturnal
6 Participants
n=282 Participants • 2 participants chose not to answer - missing data
5 Participants
n=259 Participants • 2 participants chose not to answer - missing data
11 Participants
n=541 Participants • 2 participants chose not to answer - missing data
Type of Dialysis
Other
2 Participants
n=282 Participants • 2 participants chose not to answer - missing data
2 Participants
n=259 Participants • 2 participants chose not to answer - missing data
4 Participants
n=541 Participants • 2 participants chose not to answer - missing data
Diagnoses
Diabetes
116 Participants
n=284 Participants
83 Participants
n=259 Participants
199 Participants
n=543 Participants
Diagnoses
Hypertension
182 Participants
n=284 Participants
186 Participants
n=259 Participants
368 Participants
n=543 Participants
Diagnoses
Myocardial Infarction
27 Participants
n=284 Participants
26 Participants
n=259 Participants
53 Participants
n=543 Participants
Diagnoses
Heart Disease
39 Participants
n=284 Participants
26 Participants
n=259 Participants
65 Participants
n=543 Participants
Diagnoses
Stroke
16 Participants
n=284 Participants
10 Participants
n=259 Participants
26 Participants
n=543 Participants
Diagnoses
Leg Amputation
10 Participants
n=284 Participants
7 Participants
n=259 Participants
17 Participants
n=543 Participants
Diagnoses
Lung Disease
8 Participants
n=284 Participants
15 Participants
n=259 Participants
23 Participants
n=543 Participants
Diagnoses
Liver Disease
2 Participants
n=284 Participants
6 Participants
n=259 Participants
8 Participants
n=543 Participants
Diagnoses
Arthritis
38 Participants
n=284 Participants
49 Participants
n=259 Participants
87 Participants
n=543 Participants
Diagnoses
Cancer
22 Participants
n=284 Participants
13 Participants
n=259 Participants
35 Participants
n=543 Participants
Diagnoses
Lower Back Pain
43 Participants
n=284 Participants
40 Participants
n=259 Participants
83 Participants
n=543 Participants
Diagnoses
Depression
36 Participants
n=284 Participants
31 Participants
n=259 Participants
67 Participants
n=543 Participants
Diagnoses
Other
28 Participants
n=284 Participants
33 Participants
n=259 Participants
61 Participants
n=543 Participants

PRIMARY outcome

Timeframe: Trajectories of up to 24 months from start of enrollment to study completion

Population: Intent to treat population (all participants assigned to Clinician Support and Education as well as Usual Care). Based on Imputed dataset.

Assessed using the symptoms/problems domain of the Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36). The Symptoms/Problems domain has 12 items, each representing a symptom or side effect of kidney disease based on the past 4 weeks with 5 response items ranging from "Not Bothered at all = 100" to "Extremely Bothered = 0". Min Score = 0; Max score = 100. Higher score indicates better health.

Outcome measures

Outcome measures
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
n=1196 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
n=1056 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Symptoms - Trajectory of Change
77.2 score on a scale
Standard Deviation 14.2
76.2 score on a scale
Standard Deviation 15.1

PRIMARY outcome

Timeframe: Trajectories of up to 24 months from start of enrollment to study completion

Population: Intent to treat population (all participants assigned to Clinician Support and Education as well as Usual Care). Based on Imputed dataset.

Assessed using the Patient Assessment of Care for Chronic Conditions (PACIC-20), a patient-reported experience measure on satisfaction with care over the past 6 months. The PACIC-20 is a 20-item survey based on five subscales: (1) patient activation, (2) delivery system design and decision support, (3) goal setting and tailoring, (4) problem-solving and contextual counselling, and (5) follow-up and coordination. Each item is rated on a five-point scale (from "Almost never = 0" to "Almost always = 5") and the subscale and total scores are based on average scores across items. Min score = 0; Max score = 5. Higher scores indicates higher quality of care.

Outcome measures

Outcome measures
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
n=1196 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
n=1056 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Person-centred Care - Trajectory of Change
3.4 score on a scale
Standard Deviation 1.1
3.5 score on a scale
Standard Deviation 1.0

SECONDARY outcome

Timeframe: From study enrollment until completion (up to 24 months)

Population: Health data for 5 participants classified as intervention were not found in the Alberta Health Services Database

Assessed using health services data (i.e. average number of hospital admissions, trips to the emergency room) determined through SPOR Platform and Alberta Health Services electronic health records. Higher numbers indicates worse outcomes.

Outcome measures

Outcome measures
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
n=279 Participants
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
n=259 Participants
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Utilization of Health Services
Hospitalizations
1.99 number of occurances
Standard Deviation 2.15
2.33 number of occurances
Standard Deviation 2.52
Utilization of Health Services
Emergency Room Visits
5.72 number of occurances
Standard Deviation 7.28
4.53 number of occurances
Standard Deviation 5.58

SECONDARY outcome

Timeframe: Up to 24 months from start of enrollment to study completion

Population: Intent to treat population (all participants assigned to Clinician Support and Education as well as Usual Care). Based on Imputed dataset.

Assessed using one item added to the end of the Patient Assessment of Care for Chronic Conditions 20 item questionnaire (PACIC-20) related to care received. This item is from the NHS Outpatient Survey (2011). (RateClin) related to care received on a Likert-type scale from Excellent = 1 to Very Poor = 6. Min = 1, max = 6. The number of patients who selected "1 - Excellent" was tabulated and compared between the two groups. The higher the number the more patients who felt the care provided to them was excellent.

Outcome measures

Outcome measures
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
n=1196 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
n=1056 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Number of Participants Who Selected "1 - Excellent" on Satisfaction With Care
654 Patient Reported Outcome Surveys
547 Patient Reported Outcome Surveys

SECONDARY outcome

Timeframe: Trajectories of up to 24 months from start of enrollment to study completion

Population: Intent to treat population (all participants assigned to Clinician Support and Education as well as Usual Care). Based on Imputed dataset.

Assessed using the SF-12 mental component summary (MCS) subscale in the Kidney Disease Quality of Life 36-item Short-Form Survey (KDQOL-36). The SF-12 uses 2 items (psychological distress and psychological well being) to measure the MCS score. The summary score is transformed using Canadian norm-based scoring. The scores ranged from 0 (worst health) to 100 (best health). The higher the score the better the mental health.

Outcome measures

Outcome measures
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
n=1196 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
n=1056 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Mental Health - Trajectory of Change
50.9 score on a scale
Standard Deviation 8.4
51.0 score on a scale
Standard Deviation 8.3

SECONDARY outcome

Timeframe: Trajectories of up to 24 months from start of enrollment to study completion

Population: Intent to treat population (all participants assigned to Clinician Support and Education as well as Usual Care). Based on Imputed dataset.

Assessed using the Euro Quality of Life EQ-5D-5L. This assessment uses a descriptive system for health-related Quality of Life states in adults consisting of 5 dimensions; Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression. Each dimension is scored between 1 = indicating no problem and 5 = indicating unable to/extreme problems. An EQ-5D summary index is derived by applying a formula (the Canadian standard value set) that attaches values (weights) to each of the levels in each dimension. Index min= 0.0 max = 1.0. The higher the index the better the quality of life/state of health.

Outcome measures

Outcome measures
Measure
Clinician Support and Education Around Use of PROs in Home Dialysis Clinic
n=1196 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePRO) every three months, the ePRO results for the ESASr were given to the nurse and placed in the patient chart (paper and electronic). This process helps to facilitate real time Patient Reported Outcomes (PRO) data collection and feedback in clinical practice. Educational Training and Support was provided to the multidisciplinary home dialysis clinicians on how to use the results of the patient completed ePROs routinely in their practice to support ongoing patient care. Kidney Patient Population: Northern Alberta Renal Program (NARP)
Usual Care
n=1056 Patient Reported Outcome Surveys
In this study arm home dialysis clinic patient participants completed Electronic Patient Reported Outcome Measures (ePROs) every 3 months for study comparison data but this information was not shared with the home dialysis clinic clinicians and the clinicians did not have access to participant's assessment responses. Kidney Patient Population: Southern Alberta Renal Program (SARP)
Quality of Life - Trajectory of Change
0.772 score on a scale
Standard Deviation 0.182
0.745 score on a scale
Standard Deviation 0.196

Adverse Events

Clinician Support and Education Around Use of PROs in Home Dialysis Clinic

Serious events: 0 serious events
Other events: 0 other events
Deaths: 23 deaths

Usual Care

Serious events: 0 serious events
Other events: 0 other events
Deaths: 12 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Kara Schick-Makaroff

University of Alberta

Phone: 1-780-492-9043

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place