Abstract: FR-PO959
Improving Compliance with CKD Screening and Monitoring in a Resident Continuity Clinic
Session Information
- CKD Interventions: Trials and Quality Improvement
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Eisenbeisz, McKenna, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Blaine, Adam, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Nourian, Kimiya, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Garza, Alexander Austin, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Stewart, Colten C., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Sternhagen, Erin Lynn, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Antes, Lisa M., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Jalal, Diana I., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Swee, Melissa L., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background
Chronic kidney disease (CKD) is a significant burden on the adult population, affecting up to 1 in 10 individuals. Early identification and intervention in early-stage CKD are crucial for preventing cardiovascular morbidity and mortality, specially with the availability of advanced treatment options. Guidelines recommend annual measurement of estimated glomerular filtration rate (eGFR) and proteinuria quantification in individuals at risk of CKD or with early-stage CKD. As only one third of primary care providers (PCPs) are completely confident in how to screen, diagnose, and manage CKD, we hypothesized that compliance with CKD monitoring and screening would be suboptimal in our Resident Continuity Clinic (RCC).
Methods
We conducted a quality improvement project in our RCC, comprising 34 internal medicine resident physicians serving as PCPs. We focused on patients seen in the RCC between July 1, 2020 and February 28, 2023. We assessed CKD monitoring by determining the percentage of patients with CKD, diabetes, or hypertension who underwent at least one measurement of eGFR and urine protein/creatinine or urine albumin/creatinine ratio (ACR) during the study timeframe. Patients were considered to have diabetes, hypertension, or CKD if the disease specific ICD-10 code was present on their chart.
Results
59% of the 1,811 patients seen in the RCC during the evaluation period had CKD, diabetes, or hypertension. While eGFR was measured in 90% of these patients, only 24% had eGFR and proteinuria measured. To address this gap, we implemented Plan-Do-Study-Act cycles to include resident education, introduction of an order set in the electronic medical record (EMR) to facilitate appropriate laboratory testing, and an EMR update to prompt PCPs to order yearly urine ACR for patients with diabetes. Post-intervention data will be collected quarterly, with initial results available July 2023.
Conclusion
Despite satisfactory adherence to eGFR measurements, proteinuria evaluation was underutilized. Proteinuria is an independent predictor of cardiovascular morbidity and mortality and CKD progression and has therapeutic implications. Our findings highlight the need for healthcare system interventions to ensure proper proteinuria evaluation in patients at risk for CKD.