59-OR: Improving Diabetic Kidney Disease Screening in a Veterans Affairs Primary Care Clinic

Introduction & Objective: Diabetic Kidney Disease (DKD) is a major cause of end stage renal disease. Up to half of Americans with DKD are unaware of the diagnosis and community screening rates for albuminuria varies widely. Using Lean quality improvement methods, we aimed to improve our DKD screening rate to greater than 60%. Methods: An interdisciplinary team was formed in December 2022 at a large, urban VA medical center serving approximately 20,000 Veterans with diabetes. Successful DKD screening was defined as annual serum estimated glomerular filtration rate (eGFR) and urine albumin-to-creatine ratio (UACR). Sequential interventions included provider education, system-wide monthly population health reports, elimination of ability to select incorrect lab orders, electronic reminders in EMR, and templated EMR notes to capture outside testing. Results: Screening rates for DKD improved from 54.8% to 71.3% in November 2023. Baseline drivers of poor screening included unawareness of need for UACR screening, ordering urine albumin without urine creatinine, failure to inform Veterans that a urine test was ordered, and Veterans’ inability to produce a urine sample. Conclusion: Lean methodology combined with strong change management increased UACR screening rates for DKD. Education can be effective when combined with timely supportive system interventions and regular feedback on outcomes. Disclosure A.T. Harris: None. K.P. Frangella: None. L.R. Santiago: None. P.J. Erossy: None. C. Falck-Ytter: None. N. Desai: None. E. Edmiston: None.