Ken J Park1, Robert S Unitan2, Micah L Thorp1. 1. Department of Nephrology, Kaiser Permanente Northwest, Portland, OR. 2. Department of Medical Informatics, Kaiser Permanente Northwest, Portland, OR.
Abstract
INTRODUCTION: Achievement of quality metrics in chronic kidney disease (CKD), specifically urinary albumin testing and angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use, remained lower in Kaiser Permanente Northwest compared with other Kaiser Permanente regions. We were interested if more frequent testing of urine albumin (ACR) improved CKD quality metrics. METHODS: We implemented a quality improvement project automating ACR testing using an informatics tool in patients with stage 3 CKD linked to an electronic health record (EHR) alert recommending ACEi or ARB initiation in patients with renal indication. RESULTS: At 1 and 2 years after implementation of ACR testing, ACR testing increased from 26.9% prior to implementation to 83% at 1 year and 77% at 2 year after implementation (p < 0.001). However, ACEi or ARB use did not increase significantly (65.8% vs 65.7% vs 66.4%, p = 0.54). There was also no significant change in other quality metrics, including diabetes control, hypertension control, and comanagement of higher-risk CKD patients. DISCUSSION AND CONCLUSION: In patients with stage 3 CKD, increased ACR testing via automated testing linked with EHR alert did not result in an improvement in CKD quality metrics.
INTRODUCTION: Achievement of quality metrics in chronic kidney disease (CKD), specifically urinary albumin testing and angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use, remained lower in Kaiser Permanente Northwest compared with other Kaiser Permanente regions. We were interested if more frequent testing of urine albumin (ACR) improved CKD quality metrics. METHODS: We implemented a quality improvement project automating ACR testing using an informatics tool in patients with stage 3 CKD linked to an electronic health record (EHR) alert recommending ACEi or ARB initiation in patients with renal indication. RESULTS: At 1 and 2 years after implementation of ACR testing, ACR testing increased from 26.9% prior to implementation to 83% at 1 year and 77% at 2 year after implementation (p < 0.001). However, ACEi or ARB use did not increase significantly (65.8% vs 65.7% vs 66.4%, p = 0.54). There was also no significant change in other quality metrics, including diabetes control, hypertension control, and comanagement of higher-risk CKD patients. DISCUSSION AND CONCLUSION: In patients with stage 3 CKD, increased ACR testing via automated testing linked with EHR alert did not result in an improvement in CKD quality metrics.
Authors: Sankar D Navaneethan; Julia M Akeroyd; David Ramsey; Sarah T Ahmed; Shiva Raj Mishra; Laura A Petersen; Paul Muntner; Christie Ballantyne; Wolfgang C Winkelmayer; Venkat Ramanathan; Salim S Virani Journal: Clin J Am Soc Nephrol Date: 2018-11-29 Impact factor: 8.237
Authors: Mallika L Mendu; Sri Lekha Tummalapalli; Krista L Lentine; Kevin F Erickson; Susie Q Lew; Frank Liu; Edward Gould; Michael Somers; Pranav S Garimella; Terrence O'Neil; David L White; Rachel Meyer; Scott D Bieber; Daniel E Weiner Journal: J Am Soc Nephrol Date: 2020-02-13 Impact factor: 10.121
Authors: Josef Coresh; Elizabeth Selvin; Lesley A Stevens; Jane Manzi; John W Kusek; Paul Eggers; Frederick Van Lente; Andrew S Levey Journal: JAMA Date: 2007-11-07 Impact factor: 56.272
Authors: Chester H Fox; Amanda Brooks; Luis E Zayas; William McClellan; Brian Murray Journal: J Am Board Fam Med Date: 2006 Jan-Feb Impact factor: 2.657