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Improvements in Albuminuria Screening Among Individuals with Hypertension Associated with Electronic Health Record

Waleed Zafar, Spencer Tavares, Yirui Hu

    Medrxiv : the Preprint Server for Health Sciences
    |February 23, 2026
    PubMed

    Insights

    Clinical decision support strategies significantly increased albuminuria testing in hypertension patients. These electronic health record tools improved early detection and risk stratification for cardiovascular disease and chronic kidney disease.

    Area of Science:

    • Nephrology
    • Cardiology
    • Health Informatics

    Background:

    • Albuminuria is a key risk factor for cardiovascular disease (CVD), heart failure, and chronic kidney disease (CKD) progression.
    • Early detection via urine albumin creatinine ratio (UACR) testing aids risk stratification and preventative therapy.
    • UACR testing rates remain low in the hypertension population.

    Purpose of the Study:

    • To evaluate the effectiveness of two electronic health record (EHR)-embedded clinical decision support (CDS) strategies in increasing UACR testing rates among hypertensive patients.
    • To compare UACR testing trends in a health system implementing CDS with control health systems.

    Main Methods:

    • Two EHR-embedded CDS strategies were implemented at Geisinger Health System: an OurPractice Advisory (OPA) and a Health Maintenance Topic (HMT).
    • UACR testing rates from 2020-2023 in Geisinger primary care were compared to a control group from the Optum Labs Data Warehouse (OLDW).
    • Patients with prior UACR testing, diabetes, CKD, or palliative care were excluded.

    Main Results:

    • Geisinger's UACR testing rates increased from 2.97% in 2020 to 17.5% in 2023, significantly outpacing control systems (2.08% to 3.40%).
    • The OPA strategy approximately tripled UACR testing rates.
    • The subsequent HMT strategy further enhanced testing, achieving approximately a six-fold increase from baseline.

    Conclusions:

    • EHR-embedded CDS strategies, particularly the HMT, can substantially improve UACR testing rates in hypertensive patients.
    • Effective CDS design plays a crucial role in closing care gaps for albuminuria detection.
    • Increased UACR testing facilitates better risk management for cardiovascular and kidney diseases.
    Abstract

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