Date of Graduation

2012

Document Type

Dissertation/Thesis

Abstract

Chronic kidney disease (CKD) is a major health problem in West Virginia. Primary care of CKD is suboptimal. Clinical practice guideline (CPG) usage could improve care, but CPG adoption is difficult. The Kidney Disease Outcomes Quality Initiatives (KDOQI) outlines CKD prevention and management. The primary goal of this project was to evaluate methods to increase KDOQI CPG adoption to enhance CKD diagnosis and staging in patients with diabetes mellitus (DM), the leading cause of kidney disease. Secondary goals included increasing provider knowledge and project satisfaction. Using a quasi-experimental, one group pretest/posttest design, the KDOQI CPG, an overview of CKD care, and reminders of paper and electronic (‘e’) prompts were introduced to providers and staff in one of three standardized educational sessions. Effectiveness of education and reminders for the diagnosis and staging of CKD were evaluated using pre/posttest questionnaires and post retrospective chart reviews. An end of the project provider satisfaction survey was also evaluated. During a four month period, 12 providers evaluated 52 patients with DM. Compared with 100 baseline controls, providers screened for CKD using the eGFR 29.0% at baseline vs. 86.5% during the project period, x 2 = 71, (p < .001) and CKD diagnosis was correct 68.7% vs. 93.8% of the time respectively. Stage classification improved from 0.0% to 93.8%. Missed cases of CKD declined from five to one (36.2% improvement). The number of tests done to measure urinary albumin level testing was high (>70%) both pre and post project, as was pretest provider knowledge. Confidence in CKD care and project satisfaction was high. A combination of methods was successful in promoting CPG adoption in a rural free clinic. Introduction and widespread dissemination of passive ‘e’ and paper prompts in conjunction with rigorous educational sessions are recommended to increase provider knowledge, enhance CPG adoption, and improve the recognition and diagnosis of CKD.

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