Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Increasing primary care providers' adherence with ADA guidelines for annual Urine Albumin-to-Creatinine-Ratio (UACR) screening in diabetic patients(Montana State University - Bozeman, College of Nursing, 2023) Senn, Chloe Lane; Chairperson, Graduate Committee: Alice RunningBackground: Diabetes affects over 34 million Americans in the United States, and in Montana, 9.1% of the adult population has diabetes. Diabetic kidney disease is the leading cause of end-stage renal disease, which can be easily identified and monitored by proper screening. Urine albumin-to-creatine ratio is a sensitive and early indicator for diabetic kidney disease and is essential for hindering the progression to end-stage renal disease. Therefore, the American Diabetes Association recommends annual urine albumin-to-creatine ratio screening for all diabetic patients. Problem: Compliance with urine albumin-to-creatine ratio screenings at a rural clinic in Eastern Montana was low at 29.8%, indicating a need for improvement. Methods: The project included initiating a trial protocol for ordering urine albumin-to-creatine ratio screenings, triggering a best practice alert within the electronic medical record for repeat urine albumin-to-creatine ratio screenings on positive (>30mg/g) patients, and tracking provider adherence over six weeks. The clinic set a goal of 80% compliance in ordering urine albumin-to-creatine ratio, 90% with confirmation testing on positive urine albumin-to-creatine ratio, with a long-term goal of preventing end-stage renal disease. Results: Provider adherence increased to 78.2%, slightly under the goal of 80%. Twenty-one patients screened positive for microalbuminuria. Only six had repeat testing, thus, making provider adherence to confirmation testing 28.6%. Conclusions: This project was beneficial in increasing the focus on screening for diabetic nephropathy. Implementing the trial protocol has improved the provider's adherence. Early detection improves the patient's quality of care, lowers the financial burden on the patient, reduces healthcare costs, and decreases the progression to end-stage renal disease.Item Improving diabetic nephropathy screening in a primary care clinic: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Depuydt, Kellie Ann; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Diabetes affects people worldwide and multiple organ systems thus end-organ monitoring is needed to reduce mortality and morbidity. Diabetic kidney disease is the leading cause of end-stage renal disease and is easily identified by screening. There is treatment that can prevent complications and further progression to end-stage renal disease. Despite the guidelines, patients at the site, 442 out of 705, did not have annual screening completed as of August 2021. Problem: The primary care site had not applied evidence-based practice guidelines as more than 60% of current patients with diabetes lacked urine protein screening completion from July 2020 to July 2021. Despite evidence indicating that early identification and intervention are critical, the project site did not know how many patients had early markers of chronic kidney disease and who needed treatment. Methods: This project was a single-site quality improvement project focused on increasing ordering and completion of diabetic urine protein screening plan. The project included process development and training regarding the process. The outcomes expected include staff and providers' comfort and understanding regarding process and screening orders, improvement in current screening numbers, and ultimately, treatment of diabetic kidney disease with medications and referral to nephrology if disease was identified. Results: Staff indicated comfort and knowledge with the process and correct ordering process through a survey regarding pre- and post-training. By the completion of this project, as a total 70% of patients (504 out of 720 patients; 62 patients during the 8-week project) have completed screening. Seventeen patients screened positive during the implementation of the process, and two were not on appropriate treatment of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). Conclusions: Results indicated that increasing screening was successful based on implementation of a staff protocol, training regarding ordering, and use of EMR reminders to complete screening. Primary care providers have already treated 15 out of 17 patients who screened positive with ACE or ARB for a secondary condition, usually hypertension. This project was beneficial in increasing the focus on screening, which will promote prevention from the development of end-stage renal disease for patients at this clinic long-term.