Key result
Implementation of an automated urinary albumin testing tool linked with an EHR alert significantly increased albumin testing from 26.9% to 83% at 1 year, but did not improve ACEi or ARB use.
Why the study?
Achievement of CKD quality metrics remained lower in Kaiser Permanente Northwest compared with other regions, prompting investigation into whether more frequent urine albumin testing would improve metrics.
Does an automated ACR testing and EHR alert system improve CKD quality metrics in patients with stage 3 CKD?
Observational (n=10,418)
Yes
Does an automated ACR testing and EHR alert system improve CKD quality metrics in patients with stage 3 CKD?
Answers are grounded in this paper and cite their sources.
Automating ACR testing with EHR alerts successfully increased testing rates but failed to improve downstream clinical actions like ACEi/ARB initiation or disease control in patients with stage 3 CKD.
INTRODUCTION: Achievement of quality metrics in chronic kidney disease (CKD), specifically urinary albumin testing and angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use, remained lower in Kaiser Permanente Northwest compared with other Kaiser Permanente regions. We were interested if more frequent testing of urine albumin (ACR) improved CKD quality metrics. METHODS: We implemented a quality improvement project automating ACR testing using an informatics tool in patients with stage 3 CKD linked to an electronic health record (EHR) alert recommending ACEi or ARB initiation in patients with renal indication. RESULTS: At 1 and 2 years after implementation of ACR testing, ACR testing increased from 26.9% prior to implementation to 83% at 1 year and 77% at 2 year after implementation (p < 0.001). However, ACEi or ARB use did not increase significantly (65.8% vs 65.7% vs 66.4%, p = 0.54). There was also no significant change in other quality metrics, including diabetes control, hypertension control, and comanagement of higher-risk CKD patients. DISCUSSION AND CONCLUSION: In patients with stage 3 CKD, increased ACR testing via automated testing linked with EHR alert did not result in an improvement in CKD quality metrics.
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Park et al. (2020) conducted an observational in Stage 3 Chronic Kidney Disease (n=10,418). Automated urinary albumin (ACR) testing linked with EHR alert vs. Pre-implementation (baseline care) was evaluated on Urinary albumin (ACR) testing done within 1 year (p=<0.001). Implementation of an automated urinary albumin testing tool linked with an EHR alert significantly increased albumin testing from 26.9% to 83% at 1 year, but did not improve ACEi or ARB use.
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