The National Kidney Foundation (NKF) and Sanford Health partnered to evaluate and improve overarching quality of chronic kidney disease (CKD) care among people with diabetes in the Sanford Health Population. An initial data analysis revealed low levels of urine albumin-creatinine ratio testing, gaps in CKD diagnosis in primary care settings, and limited prescription of novel interventions that could slow CKD progression and reduce associated cardiovascular risk. Recommendations from the NKF CKD Change Package were employed to develop a system-wide intervention to improve CKD testing and diagnosis and increase the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) among people with diabetes receiving care at Sanford Health.
This intervention included laboratory implementation of the NKF-recommended Kidney Profile, update of relevant electronic health record (EHR) SmartSets to ensure easy access to CKD testing and relevant guideline-directed medical therapy information, addition of CKD testing to the EHR health maintenance menu, and access to education, tools, and resources for clinicians and patients embedded in the EHR. This intervention was initiated through a series of continuing medical education webinars in December 2023. Data regarding the impact of this intervention were evaluated in October 2024. In the ten months from program kick-off, the percentage of people with diabetes receiving guideline concordant CKD testing rose from 38% at program start-up to 70%, the number of people with laboratory evidence of CKD with an ICD-10 code in their health record rose from 20% to 73%, and the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) among people with CKD rose from <2% to 9.6%.
This session will discuss the most common gaps in CKD detection and Kidney Health Evaluation for Patients with Diabetes HEDIS measure performance as well as the factors that contribute to breakdowns in CKD diagnosis and management. We will highlight the financial, operational, and clinical consequences of suboptimal CKD care and worsened patient outcomes. We will also explore the interventions that have demonstrably increased CKD quality of care.
