Audit and Feedback Supporting New Guideline Implementation in Chronic Kidney Disease

Area of Science:

• Nephrology
• Endocrinology
• Clinical Quality Improvement

Background:

• Adults with Type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) face a high risk of progressing to end-stage kidney disease (ESKD).
• ESKD significantly impacts patient health, increases healthcare costs, and reduces quality of life.
• Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are recommended to delay CKD progression in T2DM patients.

Purpose of the Study:

• To evaluate if an audit and feedback intervention can increase provider adherence to clinical practice guidelines for prescribing SGLT-2 inhibitors.
• To determine the effectiveness of this intervention in a local nephrology clinic setting.

Main Methods:

• A pretest-posttest design was employed over 3 months.
• Providers received audit and feedback at 3-week intervals, alongside a clinical decision guide.
• Participants included physicians and advanced practice providers from a southeastern US nephrology outpatient clinic.

Main Results:

• Statistical analysis showed a significant increase in SGLT-2 inhibitor prescriptions post-intervention.
• The intervention demonstrated a significant improvement in provider adherence to the guideline.
• Logistic regression confirmed the intervention's positive relationship with new SGLT-2 inhibitor prescriptions.

Conclusions:

• The audit and feedback intervention effectively increased SGLT-2 inhibitor prescribing in T2DM patients with CKD.
• Findings support the intervention's potential for broader implementation.
• Further research is needed to validate results and explore prescribing barriers.