Abstract: FR-PO0371
Improvements in Albuminuria Screening Among Individuals with Hypertension Associated with Electronic Health Record Clinical Decision Support Design Changes
Session Information
- Hypertension and CVD: Clinical - 2
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Zafar, Waleed, Geisinger Health, Danville, Pennsylvania, United States
- Tavares, Spencer, Geisinger Health, Danville, Pennsylvania, United States
- Hu, Yirui, Geisinger Health, Danville, Pennsylvania, United States
- Brubaker, Lauren, Geisinger Health, Danville, Pennsylvania, United States
- Green, Jamie Alton, Geisinger Health, Danville, Pennsylvania, United States
- Mehta, Sneha, NYU Langone Health, New York, New York, United States
- Grams, Morgan, NYU Langone Health, New York, New York, United States
- Chang, Alexander R., Geisinger Health, Danville, Pennsylvania, United States
Background
Early detection of albuminuria is important to enable accurate risk stratification and timely use of therapies that improve cardiorenal outcomes. Albuminuria screening rates are particularly low for patients with hypertension. Clinical decision support (CDS) built within the electronic health record (EHR) may offer a promising solution to address this gap.
Methods
Our multidisciplinary team at Geisinger created an our practice alert (OPA) to expand spot urine albumin creatinine ratio (UACR) testing to adults with hypertension in Jan 2022; updated in Aug 2022 to a less interruptive, more user-friendly “Storyboard”. We examined the effect of CDS strategies by comparing albuminuria screening rates at Geisinger before and after implementation to a control group of US healthcare systems (Optum Labs Data Warehouse [OLDW], a de-identified administrative claims and EHR dataset) during the same time periods. We included patients with hypertension (without diabetes or CKD) who had not had UACR test in the preceding 3 years.
Results
The study population included 58,876 individuals in Geisinger (mean age 59.4 years, 49.6% female) and 1,427,754 in OLDW (61.0 years, 49% female). UACR testing in hypertension patients successively increased after CDS changes at Geisinger (2.97% in 2020; 2.8% in 2021; 9.7% in 2022; 17.5% in 2023) compared to control health systems (2.08% in 2020; 2.26% in 2021; 3.35% in 2022; 3.40% in 2023) (Figure 1). Results were consistent after adjusting for age, sex and race.
Conclusion
An OPA increased UACR testing ~3-fold while a more user-friendly CDS change was associated with further improvements (~6-fold vs. baseline) among patients with hypertension suggesting a role for EHR-based nudges in closing this care gap.