Physician and patient tools to improve chronic kidney disease care

To determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care.

Randomized controlled trial.

We enrolled 153 primary care physicians caring for 3947 high-risk and 3744 low-risk patients with stage III CKD across 13 ambulatory health centers in eastern Massachusetts. Intervention physicians received a set of electronic alerts during office visits recommending risk-appropriate CKD care. Patients of intervention physicians also received tailored educational mailings. For high-risk patients, we assessed for a visit with a nephrologist and prescription of an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) during the 12-month study period. For low-risk patients, we assessed for a urine microalbumin screening and prescription of an ACE inhibitor or ARB during the 12-month study period.

Among high-risk patients, those in the intervention arm were significantly more likely to have an office visit with a nephrologist compared with those in the control arm (45% vs 34%; P <.001). Among low-risk patients, those in the intervention arm were significantly more likely than those in the control arm to have received urine microalbumin testing (45% vs 21%; P <.001). There was no difference between the intervention and control arms in rates of prescription of an ACE inhibitor or ARB in either the high-risk patient group (76% vs 79%; P = .17) or the low-risk patient group (64% vs 65%; P = .57).

A combined program of EHR tools and patient engagement improved some areas of CKD care, but substantial gaps remain.