Physician and patient tools to improve chronic kidney disease care

Abstract

Objectives: To determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care.

Study design: Randomized controlled trial.

Methods: We enrolled 153 primary care physicians caring for 3947 high-risk and 3744 low-risk patients with stage III CKD across 13 ambulatory health centers in eastern Massachusetts. Intervention physicians received a set of electronic alerts during office visits recommending risk-appropriate CKD care. Patients of intervention physicians also received tailored educational mailings. For high-risk patients, we assessed for a visit with a nephrologist and prescription of an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) during the 12-month study period. For low-risk patients, we assessed for a urine microalbumin screening and prescription of an ACE inhibitor or ARB during the 12-month study period.

Results: Among high-risk patients, those in the intervention arm were significantly more likely to have an office visit with a nephrologist compared with those in the control arm (45% vs 34%; P <.001). Among low-risk patients, those in the intervention arm were significantly more likely than those in the control arm to have received urine microalbumin testing (45% vs 21%; P <.001). There was no difference between the intervention and control arms in rates of prescription of an ACE inhibitor or ARB in either the high-risk patient group (76% vs 79%; P = .17) or the low-risk patient group (64% vs 65%; P = .57).

Conclusions: A combined program of EHR tools and patient engagement improved some areas of CKD care, but substantial gaps remain.