Improving the identification and management of diabetic nephropathy in patients with diabetes in primary care.

Abstract

Diabetic nephropathy is the leading cause of renal failure in the United States. Screening for albuminuria in individuals with diabetes is critical to identify the early stages of DKD. Prompt identification and management of DKD improves patient outcomes, increases life expectancy, and decreases health care costs. The DKD screening rate for patients ≥18 years of age with diabetes at the project site was 29%, below the national benchmark of 90%. Patients diagnosed with DKD were not receiving appropriate management. This quality-improvement project used a standardized protocol consisting of a checklist and educational initiatives to improve DKD identification and management. The Knowledge-to-Action Framework was used for this project at a primary care practice in the southeastern United States. Data collection included demographic data, DKD screening with urine albumin-to-creatine ratio, diagnosis rates, DKD treatment with angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), and a sodium-glucose cotransporter-2 inhibitor (SGLT2i) reviewed 6 months before and after intervention. Evidence-based interventions included a DKD educational in-service for clinical staff, creation of a standardized protocol through a checklist for screening and appropriate management of DKD, and implementation of patient educational handouts. Diabetic kidney disease screening rates increased by 100%, patients diagnosed with DKD decreased by 8%, patients with DKD on ACEi/ARB increased by 39%, and patients with DKD on SGLT2i increased by 15%. Implementation of a standardized protocol through a checklist and providing patient education on DKD can improve DKD identification/management.