Improving CKD Screening and Care in Diabetes Using Clinical Decision Support in a Large Health Care System

Area of Science:

• Nephrology
• Clinical Informatics
• Quality Improvement

Background:

• Chronic kidney disease (CKD) screening is recommended for diabetic patients using annual urinary albumin creatinine (ACR) and serum creatinine (Scr) tests.
• Screening rates were historically low in integrated healthcare systems.
• A quality improvement project was initiated to address low screening rates using clinical decision support (CDS) tools.

Purpose of the Study:

• To implement and evaluate the impact of CDS tools on increasing CKD screening rates (ACR and Scr).
• To assess the effect of improved screening on CKD quality metrics, specifically the use of ACEi/ARB and SGLT2i medications.

Main Methods:

• Implementation of CDS tools including automated lab ordering, best practice alerts (BPAs), and patient reminders.
• Provider education on CKD best practices accompanied tool implementation.
• A SGLT2i BPA was introduced and expanded to target specific patient cohorts.
• Statistical process control charts and segmented regression analysis were used to monitor trends.

Main Results:

• ACR/Scr testing rates increased from 35% to 72% within three years.
• ACEi/ARB use saw a slight increase from 74% to 76%; nephrology co-management remained stable at 53%.
• SGLT2i use showed a significant monthly increase, accelerating after BPA introduction, with a 7% higher adjusted rate in the BPA group for non-nephrology co-managed patients.

Conclusions:

• CDS tools effectively enhanced CKD screening rates in diabetic patients.
• The impact on CKD quality metrics, particularly medication use, yielded mixed results.
• Further strategies may be needed to fully optimize CKD care quality metrics alongside improved screening.