Implementation of a Kidney Screening Intervention to Improve Early CKD Detection in Adults with Diabetes

Abstract

Background: Clinical guidelines recommend that patients with diabetes mellitus (DM) are screened annually for kidney disease with eGFR and urine albumin-to-creatinine ratio (UACR). To improve screening, we implemented clinical decision support (CDS) at the University of Virginia Health System in April 2022. This included (1) autoenrollment of primary care patients with DM in an electronic health record–based health maintenance plan and (2) prompting one-click ordering of the kidney profile (panel including UACR and eGFR) or UACR alone, as needed. Methods: We assessed effectiveness of the CDS using an interrupted time series approach across three periods (pre–coronavirus disease 2019 [COVID-19] control: January 2019–February 2020; post–COVID-19 control: March 2021–April 2022; post-CDS: May 2022–April 2023). All nonacute office and telehealth encounters in primary care for patients 22 years or older with DM, no coded diagnosis of CKD in the prior 4 years, and due for screening (i.e., not screened for CKD in past 365 days). Screening was assessed as orders placed for UACR within 30 days of the encounter and aggregated by calendar months. Results: There were 66,388 encounters (23,419 pre–COVID-19 control; 22,611 post–COVID-19 control; 20,358 post-CDS). The screening trend in both control periods was similar; therefore, only the post–COVID-19 control was considered further. Demographics, encounter types, and clinic distribution were similar in the control and post-CDS periods. There was an immediate screening difference of 3.02% (95% confidence interval, 0.37 to 5.68; P = 0.03) after the CDS, and screening acceleration with a difference in screening rate of 0.57% each month compared with 0.06% per month before the CDS (P < 0.01). The results were similar if encounters for patients with prior CKD by laboratory criteria were removed. Conclusions: Roll out of CDS coincided with immediate and ongoing improvement in annual screening for CKD among adult patients with DM. These results suggest that simple CDS may be an effective intervention to promote CKD screening.