Two years after a quality improvement intervention for chronic kidney disease care in a primary care office.

Implementation of evidence-based Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines is of increasing clinical importance. This study evaluates the long-term impact of a chronic kidney disease (CKD) quality improvement (QI) project. A retrospective chart review was performed at a family practice that completed a QI project 2 years previously. In a study population of 195 patients, CKD recognition decreased during the maintenance period from 70% to 60.8% (P = 1.98), from a baseline of 38.1%, and anemia recognition declined from 70% to 50% (P =.132), from a baseline of 35%. Evaluation for parathyroid hormone, vitamin D, and phosphate decreased from 44% to 33% (P =.216), from a baseline of 4.8%. Referrals to nephrologists decreased from 77% to 61% (P = .369), from a baseline of 14%. The decrement in KDOQI guideline compliance during the maintenance period was not statistically significant, nor was there a return to baseline values. This suggests that the intervention provided the education and reinforcement necessary to effect long-term change.