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Improving chronic kidney disease care in primary care practices: an upstate New York practice-based research network
Chester H Fox1, Andrew Swanson, Linda S Kahn
1Department of Family Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York 14215, USA. chetfox@gmail.com
Journal of the American Board of Family Medicine : JABFM
|November 8, 2008
Summary
Implementing quality improvement strategies significantly enhanced chronic kidney disease (CKD) recognition and care in primary care settings. This led to improved diagnosis and management of CKD complications, including a notable increase in glomerular filtration rate.
Area of Science:
- Nephrology
- Primary Care Medicine
- Quality Improvement Science
Background:
- Chronic kidney disease (CKD) prevalence in the US has risen to 13%, necessitating better guideline implementation in primary care.
- Previous studies indicate limited physician awareness and adherence to Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines for CKD progression.
- CKD and its complications remain under-diagnosed and under-treated in primary care settings.
Purpose of the Study:
- To assess the impact of a multifaceted quality improvement intervention on CKD care in underserved primary care practices.
- To improve physician awareness, diagnosis, and management of CKD and its complications.
- To evaluate the effectiveness of practice enhancement assistants, computer decision support, and academic detailing in enhancing CKD care.
Main Methods:
- A rapid-cycle quality improvement process was implemented in two inner-city primary care practices.
- Interventions included practice enhancement assistants, computer decision-making support, and academic detailing.
- The study included 181 patients with a glomerular filtration rate <60, representing a 100% sample of CKD patients at baseline.
Main Results:
- CKD recognition significantly improved from 21% to 79% (P < .001).
- Anemia diagnosis increased significantly from 33% to 67% (P < .001).
- Mean glomerular filtration rate significantly increased from 45.75 to 47.34 (P < .001), while metformin and NSAID use decreased significantly.
Conclusions:
- A combination of practice enhancement assistants, computer decision support, and academic detailing can markedly improve CKD recognition and treatment in primary care.
- The observed significant increase in glomerular filtration rate, though small, is an encouraging outcome.
- Larger, multi-regional studies are warranted to validate these preliminary findings and confirm the efficacy of the intervention.
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