Format

Send to

Choose Destination
Am J Kidney Dis. 2018 Aug;72(2):168-177. doi: 10.1053/j.ajkd.2018.01.058. Epub 2018 Apr 23.

Impact of a Primary Care CKD Registry in a US Public Safety-Net Health Care Delivery System: A Pragmatic Randomized Trial.

Author information

1
Division of Nephrology, University of California, San Francisco, CA; Center for Vulnerable Populations at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA; Kidney Health Research Institute, University of California, San Francisco, San Francisco, CA. Electronic address: delphine.tuot@ucsf.edu.
2
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
3
Division of Nephrology, University of California, San Francisco, CA.
4
Division of General Internal Medicine at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA; Center for Vulnerable Populations at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA.
5
Division of Nephrology, University of California, San Francisco, CA; Kidney Health Research Institute, University of California, San Francisco, San Francisco, CA.
6
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Division of General Internal Medicine at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA; Center for Vulnerable Populations at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA.

Abstract

BACKGROUND:

Many individuals with chronic kidney disease (CKD) do not receive guideline-concordant care. We examined the impact of a team-based primary care CKD registry on clinical measures and processes of care among patients with CKD cared for in a public safety-net health care delivery system.

STUDY DESIGN:

Pragmatic trial of a CKD registry versus a usual-care registry for 1 year.

SETTING & PARTICIPANTS:

Primary care providers (PCPs) and their patients with CKD in a safety-net primary care setting in San Francisco.

INTERVENTION:

The CKD registry identified at point of care all patients with CKD, those with blood pressure (BP)>140/90mmHg, those without angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) prescription, and those without albuminuria quantification in the past year. It also provided quarterly feedback pertinent to these metrics to promote "outreach" to patients with CKD. The usual-care registry provided point-of-care cancer screening and immunization data.

OUTCOMES:

Changes in systolic BP at 12 months (primary outcome), proportion of patients with BP control, prescription of ACE inhibitors/ARBs, quantification of albuminuria, severity of albuminuria, and estimated glomerular filtration rate.

RESULTS:

The patient population (n=746) had a mean age of 56.7±12.1 (standard deviation) years, was 53% women, and was diverse (8% non-Hispanic white, 35.7% black, 24.5% Hispanic, and 24.4% Asian). Randomization to the CKD registry (30 PCPs, 285 patients) versus the usual-care registry (49 PCPs, 461 patients) was associated with 2-fold greater odds of ACE inhibitor/ARB prescription (adjusted OR, 2.25; 95% CI, 1.45-3.49) and albuminuria quantification (adjusted OR, 2.44; 95% CI, 1.38-4.29) during the 1-year study period. Randomization to the CKD registry was not associated with changes in systolic BP, proportion of patients with uncontrolled BP, or degree of albuminuria or estimated glomerular filtration rate.

LIMITATIONS:

Potential misclassification of CKD; missing baseline medication data; limited to study of a public safety-net health care system.

CONCLUSIONS:

A team-based safety-net primary care CKD registry did not improve BP parameters, but led to greater albuminuria quantification and more ACE inhibitor/ARB prescriptions after 1 year. Adoption of team-based CKD registries may represent an important step in translating evidence into practice for CKD management.

KEYWORDS:

CKD management; CKD registry; Chronic kidney disease (CKD); albuminuria; angiotensin converting enzyme inhibitors (ACEi); angiotensin receptor blockers (ARB); best practices; blood pressure control; disease progression; evidence-based care; guideline implementation; hypertension; pragmatic trial; process of care

PMID:
29699885
PMCID:
PMC6057801
[Available on 2019-08-01]
DOI:
10.1053/j.ajkd.2018.01.058

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center