Improving Kidney Health Screening in Primary Care Patients with Diabetes

Abstract

Purpose. This quality improvement project aims to improve kidney health screening in adult primary care patients with diabetes through provider education on screening recommendations.Background. In people with diabetes, routine kidney health screening with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) laboratory studies should be completed at least annually (American Diabetes Association [ADA], 2022; de Boer et al., 2022). Routine screening allows for early detection of kidney disease, monitors disease progression, and guides the medical management of diabetic kidney disease (ADA, 2022). The setting of this DNP project is a family practice within a regional medical group in north central Arizona. At this practice, there are low rates of kidney health screening in adult patients with diabetes. Out of 1,043 patients who met the criteria for kidney health screening in 2022, only 110 were screened, or 10.5%. Across the United States, uACR screening rates in adult patients with diabetes are consistently suboptimal, ranging from 44.7% to 63.3% (Stempniewicz et al., 2021). Methods. This project involved an educational teaching presentation at a monthly provider meeting. Six providers attended the intervention, a 15-minute educational presentation on recommendations for diabetic kidney disease screening and management. Surveys were administered before and after the intervention to assess a change in provider knowledge level. Spreadsheets were used to store and analyze data. Graphs and tables were used to represent the findings visually. Results. Pre-intervention survey results were compared to the post-intervention survey results. Questions were analyzed individually and grouped by category. Some questions had improved performance on the post-intervention survey, while others had decreased performance. The improved categories included confidence in ordering kidney screening tests recommended kidney health screening intervals, and chronic kidney disease staging and management. Categories with decreased performance include required kidney health screening tests and medication management of diabetic kidney disease. Overall, there was some improvement in provider knowledge of kidney health screening recommendations for patients with diabetes. Conclusions. This project demonstrates that provider education improves knowledge about kidney health screening recommendations in diabetes. Further study is needed to determine the impact of this study on kidney health screening rates.