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Abstract: FR-PO960

Investigating Barriers to Implementation of Functional Status Assessments in CKD Care: A Mixed Methods Study Among Stakeholders

Session Information

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Schrauben, Sarah J., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • O'Brien, Caroline S., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Bilger, Andrea, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Chronic kidney disease (CKD) clinical practice guidelines (CPG) recommend regular functional status assessments at all stages of CKD to identify those at high risk for poor functional decline. However, functional status tests are not routinely incorporated into CKD care, and the reasons for this gap have not been explored.


We used the Consolidated Framework for Implementation Research (CFIR) to guide survey and interview questions to identify barriers to implementing CPG recommended functional status assessments in CKD care. Online survey invitations were sent to stakeholders in CKD care, including staff providing direct care and administrators with decision-making roles in a large health system in southeastern Pennsylvania. Volunteers among survey respondents participated in phone interviews with a qualitative researcher. Interviews were transcribed verbatim and de-identified. Transcripts were analyzed with inductive coding as well as deductive coding using CFIR domains, and codes were grouped into themes.


Thirty-nine stakeholders in CKD care responded to surveys: 28 were nephrologists, 9 were other care staff, and 2 were administrators; 62% were women, 59% White, 31% Asian, and 5% Black. Only 36% were aware of CPG recommendations for functional testing in CKD care and 22% reported that testing was currently performed. Two-thirds of respondents agreed that functional testing should be performed in CKD care (66%) and that these tests could be conducted effectively in their clinics (69%). In the survey, the three most commonly selected barriers to performing functional testing were: clinical burden, lack of familiarity with tools, and lack of space and/or equipment. Seven respondents volunteered to be interviewed (3 nephrologists, 4 advanced practitioners). Themes identified as barriers to CPG implementation included: limited awareness/knowledge, limited resources (time, space), lack of competence/confidence in conducting tests and interpreting results, and lack of a standard operating procedure for testing.


Identified barriers, including limited awareness/knowledge, resources (time, space, equipment), and a standard procedure will inform strategies to improve the implementation of CPG recommended functional testing in CKD care.


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