Evaluation of a population health strategy to improve albuminuria detection among primary care patients with hypertension

OBJECTIVE: To study the impact of an electronic health record (EHR) alert implemented in September 2022 that prompts annual orders for urine albumin-creatinine ratio (UACR) testing for adults with hypertension (HTN). METHODS: Using segmented interrupted time-series analyses and comparative interrupted time-series analyses stratified by diabetes status, we evaluated changes in annual UACR testing rates among adults with hypertension from 1 January 2021 through 30 June 2025. RESULTS: Among 26 048 hypertensive adults (mean age, 61 years; 38.5% with diabetes), annual UACR testing rates increased from 23.8% preintervention to 37.1% postintervention. Implementation was associated with an immediate 4.05-fold increase in the odds of monthly UACR testing [odds ratio (OR) 4.05, 95% confidence interval (CI) 3.84-4.28]. Patients without diabetes experienced a larger immediate increase than patients with diabetes (OR 2.62, 95% CI 2.45-2.80). Patients with UACR at least 30 mg/g were more likely to receive angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blockers and SGLT2 inhibitor therapy than patients with UACR less than 30 mg/g or those never tested (P < 0.001). CONCLUSION: Implementation of an EHR-integrated UACR alert increased annual UACR testing among adults with HTN. Irrespective of the EHR alert, UACR testing was associated with greater use of guideline-concordant medications. POLICY IMPLICATIONS: This easily implemented intervention has the potential to improve guideline-concordant care for patients with HTN in primary care.