Improving CKD Screening in Spanish-Speaking Patients with Poorly Controlled Type 2 Diabetes at a Rural Community Health Center
- 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
- Kenan, Anna, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Munir, Naeemah, Piedmont Healthcare Inc, Siler City, North Carolina, United States
The American Diabetes Association (ADA) and Kidney Disease Improving Global Outcomes (KDIGO) consensus recommendations advise that patients with type 2 diabetes (T2DM) undergo annual screening with urine microalbumin creatinine ratio and estimated glomerular filtration rate. Less than half of patients with T2DM receive the recommend screening. This project aimed to increase CKD screening in Spanish-Speaking patients with poorly controlled T2DM (A1c>9) by 5% over 2 months at a community health center in rural North Carolina and evaluated secondary patient-centered outcomes of initiation of sodium glucose cotransporter 2 inhibitors (SGLT2i) and diagnosis with CKD.
We performed chart review querying for Spanish-speaking patients at SCCHC with T2DM with A1c>9 without a diagnosis of CKD (n=134). We then created a pop-up alert for patients without any CKD screening in the past year. We performed patient outreach to schedule appointments, offer counseling on CKD screening, and pend labs. Finally, we generated a flier for providers summarizing ADA and KDIGO guidelines for CKD screening and initial management.
Only 43% of patients received full screening at baseline. Overall, the number of patients screened for CKD increased by 7%. 85% of patients with alerts in their charts who showed up for appointments received full screening. 50% of patients contacted through patient outreach scheduled an appointment and all patients who were seen in clinic following outreach received full screening. Only 29% of patients for whom the only intervention was provider education recieved complete screening. No diagnoses of CKD were made as a result of screening. There was an increase in prescription of an SGLT2i from 35% to 69% in patients recieving any CKD screening.
The improvement in CKD screening resulting from this project supports the need for pre-visit planning tools that highlight CKD screening, for patient education efforts, and for a one click ‘Kidney Profile’ lab order. The increased use of SGLT2i in patients recieving full screening supports a correlation between CKD screening and increased risk reduction therapy. Future efforts to increase appropriate CKD diagnosis and patient counseling following screening will be important for empowering patients to prevent disease progression.