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Bring Personalized Risk-Scoring to the Point-of-Care
The DECIO CDS platform gives clinicians powerful predictive analytics that support shared decisions at the point-of-care. DECIO’s disease specific modules empower patients and doctors with ownership of protocol initiation, treatment strategy agreement, and outcome measurement.
Clinical organizations interested in deploying the DECIO CDS platform can set up a demonstration by emailing DECIO@mtppi.org
CASE STUDY: A large nephrology practice was looking for a way to discuss treatment options with elderly kidney disease patients. Advanced kidney disease is particularly challenging for older patients since treatment options are usually limited. While most patients diagnosed with ESRD choose to initiate dialysis, this modality may not be the best choice for elderly patients due to the higher mortality that occurs in the first few months of treatment.
Against this outcomes profile, the practice group asked for a risk scoring tool that allowed patients to make a truly informed decision.
MTPPI built an Android app that could be deployed to tablet devices. Providers could sit with their patients and family members and use the simple risk score (0-9) to estimate the risk of early mortality after dialysis therapy initiation.
To develop the scoring algorithm, MTPPI researchers accessed a large, national administrative database which contained the near-universe of elderly Medicare-entitled dialysis patients in the United States. Chosen study end points were all-cause mortality within the first 3 months (primary) and mortality within the first 6 months (secondary). Input variables chosen as potential predictors of mortality were age, sex, race, socioeconomic status, comorbid conditions, and a composite variable for assistance with daily living. The research team also identified variables specific to renal care such as the involvement and
timing of nephrologist care prior to ESRD, vascular access placement (graft/fistula vs catheter), and laboratory data at dialysis therapy initiation (eg, serum albumin, serum creatinine, estimated glomerular filtration rate, and hemoglobin). The final development and validation cohorts included 52,796 and 16,645 patients, respectively. Using these cohorts, MTPPI derived comprehensive and simple risk scores to predict mortality in the
first 3 and 6 months after initiating dialysis therapy.
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