Chronic kidney disease requires a complex array of treatment interventions, including dietary and fluid restriction, medications, and self-monitoring of blood pressure. Patient well-being is directly linked to adhering to physician recommendations and treatment schedules. While considerable efforts have been directed to understanding the contribution of patient characteristics, burden of treatment, and patient-provider relations, little study has been conducted on the "system" requirements that support good patient-provider communication. This study examines how operational characteristics occurring at the time of an encounter affect the likelihood a patient will "hear" provider recommendations.