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Randomized Controlled Trial
. 2020 May;35(5):1435-1443.
doi: 10.1007/s11606-019-05353-4. Epub 2019 Dec 10.

Translating CKD Research into Primary Care Practice: a Group-Randomized Study

Cara B Litvin  1 , Paul J Nietert  2 , Ruth G Jenkins  3 , Andrea M Wessell  3 , Lynne S Nemeth  4 , Steven M Ornstein  3
Affiliations
Randomized Controlled Trial

Translating CKD Research into Primary Care Practice: a Group-Randomized Study

Cara B Litvin et al. J Gen Intern Med. 2020 May.

Abstract

Background: Chronic kidney disease (CKD) is common in the primary care setting. Early interventions may prevent progression of renal disease and reduce risk for cardiovascular complications, yet quality gaps have been documented. Successful approaches to improve identification and management of CKD in primary care are needed.

Objective: To assess whether implementation of a primary care improvement model results in improved identification and management of CKD DESIGN: 18-month group-randomized study PARTICIPANTS: 21 primary care practices in 13 US states caring for 107,094 patients INTERVENTIONS: To promote implementation of CKD improvement strategies, intervention practices received clinical quality measure (CQM) reports at least quarterly, hosted an on-site visit and 2 webinars, and sent clinician/staff representatives to a "best practice" meeting. Control practices received CQM reports at least quarterly.

Main measures: Changes in practice adherence to a set of 11 CKD CQMs KEY RESULTS: We observed significantly greater improvements among intervention practices for annual screening for albuminuria in patients with diabetes or hypertension (absolute change 22% in the intervention group vs. - 2.6% in the control group, p < 0.0001) and annual monitoring for albuminuria in patients with CKD (absolute change 21% in the intervention group vs. - 2.0% in the control group, p < 0.0001). Avoidance of NSAIDs in patients with CKD declined in both intervention and control groups, with a significantly greater decline in the control practices (absolute change - 5.0% in the intervention group vs. - 10% in the control group, p < 0.0001). There were no other significant changes found for the other CQMs. Variable implementation of CKD improvement strategies was noted across the intervention practices.

Conclusions: Implementation of a primary care improvement model designed to improve CKD identification and management resulted in significantly improved care on 3 out of 11 CQMs. Incomplete adoption of improvement strategies may have limited further improvement. Improving CKD identification and management likely requires a longer and more intensive intervention.

Keywords: chronic kidney disease; primary care; quality improvement.

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Conflict of interest statement

Dr. Wessell reports that she is the Clinical Director of the DARTNet Institute Patient Safety Organization, which has adopted similar medication safety measures for patients with chronic kidney disease as reported in this paper. The authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
Translating CKD research into practice logic model.
Figure 2
Figure 2
Consort study diagram.
See this image and copyright information in PMC

References

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