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Erschienen in:
10.12.2019 | Original Research
Translating CKD Research into Primary Care Practice: a Group-Randomized Study
Erschienen in: Journal of General Internal Medicine | Ausgabe 5/2020
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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.