Kidney Week

Abstract: FR-PO258

Implementation of a CKD Panel Management Tool for Resident Physicians

Session Information

• CKD: Clinical, Outcomes, Trials - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Howard, Frederick Matthew, Yale School of Medicine, Cheshire, Connecticut, United States

Frederick Matthew Howard,

• Connolly, James J., Yale School of Medicine, Cheshire, Connecticut, United States

James J. Connolly,

• Ackley, William, Yale School of Medicine, Cheshire, Connecticut, United States

William Ackley,

• Harada, Kaoru, Yale School of Medicine, Cheshire, Connecticut, United States

Kaoru Harada,

• Kunnirickal, Steffne J., Yale School of Medicine, Cheshire, Connecticut, United States

Steffne J. Kunnirickal,

• Merchant, Naseema Banu, Yale School of Medicine, Cheshire, Connecticut, United States

Naseema Banu Merchant,

• Perazella, Mark A., Yale School of Medicine, Cheshire, Connecticut, United States

Mark A. Perazella,

Background

Chronic kidney disease (CKD) affects approximately 1 in 7 adults and over one million Veterans served by the Veterans Health Administration (VHA). These patients are at increased risk for numerous adverse sequelae, including anemia, metabolic acidosis (MA), proteinuria, mineral bone disease (MBD), and hypertension. Clinical practice guidelines have been published by the Kidney Disease: Improving Global Outcomes work group to assist clinicians in managing the sequelae of CKD, but guideline compliance was low in a test cohort of patients cared for by residents working at a VHA Medical Center.

Methods

We designed a panel management tool to provide an automated summary of guideline-based interventions relevant to each patient seen in clinic. Residents received up to 16 recommendations per patient – eight focusing on work-up of anemia, five on MBD, and one each on uncontrolled hypertension, evaluation for albuminuria, and correction of MA. Guideline compliance, both overall and for specific domains of care, was compared pre- and post-intervention using a two-sided t-test.

Results

We identified 365 encounters with patients with at least stage III CKD (eGFR < 60 ml/min/1.73 m²) during the six months prior to intervention, and 272 encounters in the first four months of our intervention. Guideline compliance increased from 53.5 ± 1.3% pre-intervention to 61.0 ± 2.5% post-intervention (p < 0.01). In a subgroup analysis, there were significant improvements in MBD testing (40.0 ± 2.4% vs 53.0 ± 2.9%) and albuminuria screening (25.6 ± 2.0% vs 42.1 ± 3.3%).

Conclusion

Implementation of a panel management tool achieved significant improvement in overall guideline compliance, with particular efficacy in the domains of MBD and albuminuria screening. The short time course of the intervention may have limited our ability to assess for improvement in blood pressure control and MA. This effective tool could be universally applied to improve the management of CKD by VHA providers.

Funding

• Veterans Affairs Support