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A Quality Improvement Initiative Targeting Chronic Kidney Disease Metrics Through Increased Urinary Albumin Testing
Ken J Park1, Robert S Unitan2, Micah L Thorp1
1Department of Nephrology, Kaiser Permanente Northwest, Portland, OR.
The Permanente Journal
|February 26, 2021
Summary
Automated urine albumin testing (ACR) in chronic kidney disease (CKD) patients increased significantly. However, this did not improve medication use (ACEi/ARB) or other CKD quality metrics, indicating a need for different interventions.
Area of Science:
- Nephrology
- Health Informatics
- Quality Improvement
Background:
- Chronic kidney disease (CKD) quality metrics, including urinary albumin testing and ACEi/ARB use, were lower in Kaiser Permanente Northwest.
- Improving these metrics is crucial for effective CKD management.
Purpose of the Study:
- To evaluate if increased urine albumin-to-creatinine ratio (ACR) testing improves CKD quality metrics.
- To assess the impact of automated ACR testing linked to EHR alerts on ACEi/ARB initiation.
Main Methods:
- A quality improvement project automated ACR testing for stage 3 CKD patients.
- An informatics tool linked EHR alerts to recommend ACEi/ARB for renal indications.
Main Results:
- ACR testing rates increased from 26.9% to over 80% post-implementation (p < 0.001).
- No significant increase in ACEi or ARB use was observed (65.8% vs. 66.4%, p = 0.54).
- Other quality metrics, including diabetes and hypertension control, also showed no significant change.
Conclusions:
- Automated ACR testing linked with EHR alerts did not improve CKD quality metrics in stage 3 CKD patients.
- Further strategies are needed to enhance the use of guideline-recommended therapies in CKD care.
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