A Quality Improvement Project to Increase CKD Screening in Diabetics
- Diabetic Kidney Disease: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
- Park, Ken J., Kaiser Permanente Northwest, Portland, Oregon, United States
- Nakashimada, Lisa J., Kaiser Permanente Northwest, Portland, Oregon, United States
- Albright, Eric S., Kaiser Permanente Northwest, Portland, Oregon, United States
The ADA recommends that patients with DM should be screened for CKD annually with a urinary albumin (ACR) and serum creatinine (Scr). However, CKD screening remains low at 10-40%. In addition, ACEi or ARB’s and SGLT2 inhibitors are under prescribed. We implemented a quality improvement project to increase annual screening for CKD in DM. We were also interested in whether increased CKD screening increased prescribing of ACEi or ARB’s, SGLT2-inhibitors, and co-management with nephrology.
This is a quality improvement project of Kaiser members in the Portland Metro area between ages of 18-85 with DM (~40,000 pts). Patients with ESRD, on hospice or palliative care, <1 yr Kaiser enrollment, living in long term care facility, >66 with frailty and advanced illness, or >81 with frailty were excluded. Auto ordering of Scr and ACR in patients who had not had either lab resulted within the past year was rolled out on May 11, 2022. Providers received an EHR alert at time of visit reminding them that patients were due for labs. Patients also received automated letters, texts, and phone calls on their birthday to go to the lab. Data was collected cross sectionally at the beginning of the month and the percent of patients with Scr and ACR tested within the past year were reviewed monthly. Prescribing of ACEi/ARB, SGLT2-inhibitors, and nephrology co-management within 1 year was also tracked. Trends were reviewed using control charts.
By 10 months after rollout, we saw an increase in ACR and Scr testing from 35% to 71%. We saw a small increase in ACEi or ARB use in patients with DM with hypertension and ACR ≥ 30 mg/gm from mean of 82% to 82.3%. There was no change in percent of patients with renal indication seen by nephrology which stayed around 28%. We saw an increase in SGLT2-inhibitors use in patients with renal indication from 10% to 16%. However, the improvement was occurring prior to rollout of the intervention making it unclear if the increase was a result of an increase in ACR and Scr testing.
Our findings suggest that use of auto ordered labs and automated outreach can result in significant improvement in CKD screening amongst diabetics. We saw a statistically but clinically insignificant increase in ACEi/ARB use after the intervention. We saw a larger increase in SGLT2-inhibitors use although we could not attribute this to increased ACR and Scr testing.