CIHR grant will support first-of-its-kind research in Canada using electronic health-care records

Neesh Pannu, nephrologist and professor in the Department of Medicine

If you’ve never heard of acute kidney injury (AKI) you’re not alone. It’s the loss of kidney functions that occurs in acutely ill patients while in hospital. Despite affecting almost one in five people who have been hospitalized, it’s an underdiagnosed and potentially fatal health condition.

“AKI can only be detected through lab testing, and because it often appears as a subtle change in test results, doctors don’t recognize it,” explains Neesh Pannu, a nephrologist and professor in the Department of Medicine. “We know many, but not all survivors of AKI will have significant long term health problems related to this condition in the future.” 

Those health problems include a 40 percent increased risk of dying and a 50 to 60 percent increased risk of having a cardiovascular event — a heart attack or stroke — within a year.

That’s why over the next four years, Pannu and a team of researchers from the University of Alberta, the University of Calgary, health-care and health-systems professionals from Alberta Health Services (AHS) and patients living with AKI will work together in a CIHR Transitions in Care funded research project to improve diagnosis, risk assessment , and community care for these patients. The study is called Using personalized risk and digital tools to guide transitions following acute kidney events - A pragmatic randomized controlled trial in Connect Care.

The project is the first of its kind to leverage data from Alberta’s new clinical information system, Connect Care, to both identify a health condition and improve patient care and outcomes.  

The two-stage study will take four years to complete. The initial stage of the work will be data-driven, using algorithms in electronic health records to identify cases of AKI.

Once the ability to diagnose is improved, the next stage of the research will involve determining how to provide better patient care. Pannu and the research team will work with an AHS clinical system design group to embed tools within Connect Care to assess their risk of long term complications and direct them to the most appropriate care.

“We (nephrologists) need to be involved in the care of those who are at highest risk of having long term complications. People with the highest -risk of AKI complications will be referred to see kidney specialists, those with medium- to low-risk can be safely sent back to their family physician with information about the most appropriate care, and when to refer them to a nephrologist if necessary,” says Pannu. “It’s about making sure the right care gets to the patient at the right time. Ultimately, it's about personalizing care.”

The transition from hospital back to home is an important step in patient care, and ensuring that process goes smoothly is a priority. This will involve working with both AHS Strategic Clinical Networks and the AHS Home to Hospital to Home initiative. Communication with patients is also a crucial part of this process, so patients who have had AKI are also included in the research team.

“This will really empower patients by giving them more information about their health conditions, and improve communication between the hospitals and primary care providers,” acknowledges Pannu.
This is groundbreaking work, not only because it’s the first study of its kind b that leverages electronic health records to target and deliver care, but also because it may lead to improved care for other health conditions. Pannu hopes the team’s work will create a template for medical specialists and researchers to implement important health interventions for future health-care studies. 

“This gives us the power to be able to look to see if some of the treatments that we know are effective can be implemented into clinical care,” says Pannu. “We have a tremendous opportunity to leverage this provincial electronic health record that captures the health of every Albertan. Being able to use the information within that electronic health record to target proven treatments will improve the care for everyone in the province.”