Increasing primary care providers' adherence with ADA guidelines for annual Urine Albumin-to-Creatinine-Ratio (UACR) screening in diabetic patients

Abstract

Background: 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.