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Kidney Week

Abstract: TH-OR58

Implementation of a Kidney Screening Intervention to Improve Early CKD Detection in Type 2 Diabetes (T2D)

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Spolnik, Margaret, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Sharma, Binu, UVA Health, Charlottesville, Virginia, United States
  • Ellwood, Michael R., UVA Health, Charlottesville, Virginia, United States
  • Ma, Jennie Z., UVA Health, Charlottesville, Virginia, United States
  • Lyman, Jason A., UVA Health, Charlottesville, Virginia, United States
  • Scialla, Julia J., UVA Health, Charlottesville, Virginia, United States
Background

American Diabetes Association and KDIGO guidelines recommend annual screening with UACR and eGFR in patients with T2D. To improve screening, we implemented clinical decision support (CDS) in April 2022 at University of Virginia Health System (UVA), including: (1) auto-enrollment of primary care patients with T2D in the EPIC health maintenance plan; and (2) prompting one-click ordering of the Kidney Profile (KP; panel including UACR and eGFR) or UACR alone, as needed, to satisfy screening.

Methods

We assessed effectiveness of the CDS by comparing screening across 3 periods (pre-COVID control: Jan 2019-Feb 2020; post-COVID control: Mar 2021- Apr 2022; post-CDS: May 2022 - Oct 2022) for all non-acute office, nursing and telehealth encounters in UVA primary care for T2D patients aged ≥22 years. Encounters with a coded diagnosis of CKD in the prior 4 yrs or fully screened for CKD in past 365 days were excluded. Orders for UACR testing within 30 days constituted screening. Rates were aggregated by calendar months and compared via interrupted time series. Sensitivity analyses included all primary care encounters during this period.

Results

There were 59,147 encounters (24,242 pre-COVID control; 23,413 post-COVID control; 11,492 post-CDS). The screening trend in both control periods was similar, therefore only the post-COVID control was considered further. Demographics, encounter types, and clinic distribution were similar in the control and post-CDS periods. There was no immediate impact on screening (p=0.4), but screening accelerated post-intervention (p=0.003, Figure). Results were similar if all primary care encounters were included (e.g., inclusive of acute visits).

Conclusion

Roll out of CDS coincided with acceleration of the screening rate for CKD among adult patients with T2D. These results suggest that simple CDS may be an effective intervention to promote annual CKD screening.

Screening rates by month pre/post intervention. Blue line depicts the control rate of screening. Red line depicts observed screening after the intervention.

Funding

  • Other U.S. Government Support