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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
PubMed

Insights

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.
Abstract

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