Screening for diabetic kidney disease in primary care for the underinsured: A quality improvement initiative

Hughes-Carter, Della L.; Hoebeke, Roberta

doi:10.1016/j.apnr.2015.11.008

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…18 Some studies in primary care settings used clinical support tools and provider education to improve testing rate disparities related to patient minority status [19][20][21] or uninsured status. 22 Several QI studies focused on electronic health record (EHR)-based interventions. These EHR-based reminders and monitoring improved compliance with albuminuria testing in primary care settings.…”

Section: Open Accessmentioning

confidence: 99%

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Improving annual albuminuria testing for individuals with diabetes

et al. 2022

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BackgroundAnnual albuminuria screening detects the early stages of nephropathy in individuals with diabetes. Because early detection of albuminuria allows for interventions that lower the risk of developing chronic kidney disease, guidelines recommend annual testing for all individuals with type 2 diabetes mellitus and for those with type 1 diabetes for at least 5 years. However, at the Eskind Diabetes Clinic at the Vanderbilt University Medical Center, testing occurred less frequently than desired.MethodsA quality improvement team first analysed the clinic’s processes, identifying the lack of a systematic approach to testing as the likely cause for the low rate. The team then implemented two successive interventions in a pilot of patients seen by nurse practitioners in the clinic. In the first intervention, staff used a dashboard within the electronic health record while triaging each patient, pending an albuminuria order if testing had not been done within the past year. In the second intervention, clinic leadership sent daily reminders to the triage staff. A statistical process control chart tracked monthly testing rates.ResultsAfter 6 months, annual albuminuria testing increased from a baseline of 69% to 82%, with multiple special-cause signals in the control chart.ConclusionsThis project demonstrates that a series of simple interventions can significantly impact annual albuminuria testing. This project’s success likely hinged on using an existing workflow to systematically determine if a patient was due for testing and prompting the provider to sign a pended order for an albuminuria test. Other diabetes/endocrinology and primary care clinics can likely implement a similar process and so improve testing rates in other settings. When coupled with appropriate interventions to reduce the development of chronic kidney disease, such interventions would improve patient outcomes, in addition to better adhering to an established quality metric.

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Section: Open Accessmentioning

confidence: 99%

“… 18 Some studies in primary care settings used clinical support tools and provider education to improve testing rate disparities related to patient minority status 19–21 or uninsured status. 22 …”

Section: Introductionmentioning

confidence: 99%

Improving annual albuminuria testing for individuals with diabetes

et al. 2022

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“…Some studies suggest that screening for albuminuria in patients at risk for DKD may be underused in primary care [ 12 , 66 ]. Unsurprisingly, family practice physicians and general internists were less aware of clinical practice guidelines for CKD than nephrologists [ 67 ].…”

Section: Barriers To Dkd Managementmentioning

confidence: 99%

“…The use of select microalbuminuria detection strips can provide results similar to the actual albumin:creatinine ratio [ 113 ]. In primary care settings, improved screening rates for microalbuminuria in patients with diabetes can be achieved by quality improvement processes that include education of staff on clinical practice guidelines [ 66 ]. In addition to diabetes, population characteristics of persons at increased risk for whom screening for CKD should be considered include those with hypertension, family history of CKD, low socioeconomic status, the elderly, and high-risk racial/ethnic groups [ 54 , 114 – 119 ].…”

Section: Recommendations For Better Dkd Managementmentioning

confidence: 99%

“…In patients with known DKD, eGFR should be monitored more frequently; every 6 months if eGFR is 45–60 mL/min/1.73 m 2 and every 3 months if eGFR is 30–44 mL/min/1.73 m 2 [ 8 ]. Serum creatinine can be measured in a spot blood sample and eGFR estimated using various equations [ 120 ] either by a clinical laboratory or by online eGFR calculators [ 66 ], although most clinical labs now automatically report eGFR compared with less than 50% only 10 years ago [ 121 ].…”

Section: Recommendations For Better Dkd Managementmentioning

confidence: 99%

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The Landscape of Diabetic Kidney Disease in the United States

et al. 2018

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Purpose of ReviewThe purposes of this review are to identify population characteristics of important risk factors for the development and progression of diabetic kidney disease (DKD) in the United States and to discuss barriers and opportunities to improve awareness, management, and outcomes in patients with DKD.Recent FindingsThe major risk factors for the development and progression of DKD include hyperglycemia, hypertension, and albuminuria. DKD disproportionately affects minorities and individuals with low educational and socioeconomic status. Barriers to effective management of DKD include the following: (a) limited patient and healthcare provider awareness of DKD, (b) lack of timely referrals of patients to a nephrologist, (c) low patient healthcare literacy, and (d) insufficient access to healthcare and health insurance.SummaryIncreased patient and physician awareness of DKD has been shown to enhance patient outcomes. Multifactorial and multidisciplinary interventions targeting multiple risk factors and patient/physician education may provide better outcomes in patients with DKD.Electronic supplementary materialThe online version of this article (10.1007/s11892-018-0980-x) contains supplementary material, which is available to authorized users.

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