Introduction of a dashboard visualizing outcome information during healthcare visits in Chronic Kidney Disease - An evaluation study.

Abstract

Effective patient-clinician communication is essential in chronic kidney disease (CKD) to support treatment adherence and slow down disease progression. In this proof-of-concept study we evaluated the effects of a CKD dashboard, designed to visualize clinical and patient-reported outcomes during healthcare visits, on patient activation and shared decision making (SDM). We conducted a prospective, multiple-methods pre-post study in two Dutch teaching hospitals (January 2021-June 2022); one intervention hospital where the dashboard was implemented, one control. Patient questionnaires were collected at three time points: pre-implementation (T0); post-implementation (T1); one year after implementation (T2). Healthcare visits at T0 and T1 were audio-recorded. Primary outcome was the Patient Activation Measure, PAM, range 0-100). Secondary outcomes included SDM, range 0-24, motivational interviewing (MI), and patient-reported experiences of care. In total, 126 patients participated. The mean PAM at T0 was 56.6 in the intervention hospital, with no significant changes at T1 (56.6) or T2 (56.2), nor significant differences with the control hospital. Secondary outcomes showed similar patterns. We analyzed 247 decisions from 193 recorded visits. Median SDM scores did not differ significantly between hospitals or over time (T0: Md=4.5 vs. 3.5; T1: Md=6.0 vs. 7.25). However, visits in which the dashboard was used as intended showed higher SDM levels compared to visits in which it was not used as intended: Md= 8.0 (IQR,13.5-3.5) versus 2.75 (IQR, 4.4-0.0), p = 0.008. The dashboard encouraged discussion of under-addressed topics, such as mental and sexual health, without neglecting other CKD-related issues. Patients expressed satisfaction with the information provided. Although patient activation and SDM levels did not change in the timeframe of this study, the dashboard facilitated broader discussions, contributing to actionable outcomes. Dashboard effects may increase when successfully embedded in routine care and accessible to patients at home. Trainings in applying SDM across a broad range of decisions is needed. NCT05931978.