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Screening for Nephropathy in Pediatric Type 2 Diabetes: Quality Improvement to Increase Nephropathy Screening
Elizabeth A Mann1, Kelsi Alexander1, Whitney Beaton2
1From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Insights
Early screening for kidney disease in youth with type 2 diabetes is crucial. A quality improvement initiative successfully increased and sustained urine nephropathy screening rates in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Quality Improvement Science
Background:
- Microalbuminuria screening is vital for early kidney disease detection in youth-onset type 2 diabetes.
- Standardizing screening protocols is essential at the time of diagnosis.
- A quality improvement initiative targeted pediatric type 2 diabetes patients at a tertiary academic medical center.
Purpose of the Study:
- To standardize urine nephropathy screening in pediatric patients with type 2 diabetes.
- To increase the baseline screening rate from 56% to 75% within 6 months.
- To sustain the increased screening rate for an additional 6 months.
Main Methods:
- Employed quality improvement methods and iterative Plan-Do-Study-Act cycles.
- Implemented interventions including previsit planning, education, and a new-onset triage protocol.
- Collected data through electronic medical record reviews, measuring screening rates at clinic visits.
Main Results:
- Urine nephropathy screening rates increased from a baseline of 56% to 75%.
- This significant increase was sustained for the subsequent 6-month period.
- The study involved 121 youth with type 2 diabetes, with a mean age of 14.5 years.
Conclusions:
- Interventions focused on efficient screening identification and coordinated processes improved screening rates.
- Shared understanding among stakeholders and practical healthcare system support were key to success.
- The initiative demonstrated sustained improvement in urine nephropathy screening for pediatric type 2 diabetes patients.
Background:
Screening for early detection of microalbuminuria signaling kidney disease should begin as early as the time of diagnosis of youth-onset type 2 diabetes. This quality improvement initiative aimed to standardize urine nephropathy screening in pediatric patients with type 2 diabetes at a tertiary academic medical center and increase a baseline screening rate of 56%-75% over 6 months (September 2022-February 2023) and sustain that increase for 6 months (March through August 2023).
Methods:
A multi-disciplinary team used quality improvement methods and iterative Plan-Do-Study-Act cycles. Targeted interventions included previsit planning workflow, education, and a new-onset triage protocol. The team collected data at baseline and prospectively by reviewing electronic medical records. The primary outcome measure was pediatric type 2 diabetes clinic visits in diabetes clinic with urine nephropathy screening before or on the visit date.
Results:
A total of 121 youth were scheduled for T2D clinic visits between September 2021 and August 2023. The mean age was 14.5 years, and 60% were women, 40% were non-Hispanic Black, 28% were Hispanic/Latino, and 15% reported Spanish as their preferred language. Following the interventions of this project, urine nephropathy screening increased from 56% to 75%, and this change was sustained for 6 months.
Conclusions:
Interventions focused on efficient recognition of the population needing screening, coordinated internal processes around screening, a shared understanding between all stakeholders, and practical support in the healthcare system increased urine nephropathy screening with sustained improvement.
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