Abstract: PUB083
Quality Improvement to Increase Urine Protein-to-Creatinine Ratio Testing in Outpatient CKD Clinics: A WE ACT Approach
Session Information
Category: Educational Research
- 1000 Educational Research
Authors
- Nenwani, Hari Vishal, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Kouyate, Gnama, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Delp, Crystal, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Akatibo, Emmanuel, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Safi, Adnan, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Syed, Jahanghir, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Suraj, Fnu, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Salifu, Moro O., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Saggi, Subodh J., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
Background
Proteinuria is a validated surrogate marker of chronic kidney disease progression, yet urine protein-to-creatinine ratio (UPCR) ordering and completion remain inconsistent in outpatient nephrology practice. Electronic medical record (EMR) reminders and standardized workflows improve albuminuria screening in primary care, but similar interventions in specialty CKD clinics are understudied. We designed a quality improvement project to increase UPCR testing at an academic nephrology clinic.
Methods
Using the WE ACT methodology, we conducted a baseline assessment from January to March 2024 at the SUNY Downstate Nephrology Clinic. We measured UPCR ordering and completion rates among CKD outpatients and performed root cause analysis identifying workflow gaps: lack of EMR reminders, variable provider ordering patterns, absence of standardized visit checklists, limited patient education, and lab coordination challenges. Interventions included EMR-embedded reminders for CKD visits, a standardized clinic checklist, provider and patient education materials, and monthly compliance audits with feedback. The primary outcome was the UPCR ordering rate; the secondary outcomes included completion rates and time to result.
Results
Baseline data showed 71.57% of CKD patients had a recent UPCR within 3 months, but only 15.69% received a new order during visits, highlighting workflow variability and missed monitoring opportunities. After EMR reminder implementation, preliminary data show improved UPCR ordering, with ongoing analysis of sustainability and completion rates.
Conclusion
Systematized UPCR monitoring through EMR decision support and standardized workflows may improve proteinuria surveillance in specialty CKD clinics. This project provides a replicable framework for outpatient nephrology quality improvement with the potential to enhance risk stratification and guide therapeutic adjustments.