142nd APHA Annual Meeting and Exposition

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Kidney Awareness Registry and Education (KARE) study: Impact of a primary care chronic kidney disease (CKD) registry on CKD management in a safety-net setting

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Alexandra Velasquez, BS , Department of General Internal Medicine and Division of Nephrology at San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
Delphine Tuot, MD , Division of Nephrology at San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
Charles McCulloch, PhD , Division of Biostatistics, University of California, San Francisco, San Francisco, CA
Tanushree Banerjee, PhD , Department of General Internal Medicine at San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
Neil Powe, MD, MPH, MBA , Department of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, CA
Background: CKD affects 20+ million US adults, causing excess morbidity and mortality, particularly among low-income, minority populations. Early stage CKD is asymptomatic; detection by primary care providers (PCPs) is critical to prevent disease progression via blood pressure (BP) control, minimization of albuminuria and prescription of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB). This goal remains elusive.

Objective: We examined the impact of an electronic CKD registry in a federally qualified primary care clinic with a racially/ethnically diverse low-income patient population. At point of care, the registry identifies patients with CKD and those who need an ACEi/ARB prescription and includes standing orders to empower non-physician health care team members to quantify albuminuria. Quarterly feedback is provided with team-based and individual PCP metrics about delivery of CKD care.

Methods: Health care teams were randomized to the registry or usual care. Using generalized estimating equations to account for provider clustering, we assessed the impact of the registry, time and their interaction on change in proportion of patients with BP control <140/90, measurement of albuminuria and prescription of ACEi/ARB.

Results: Patients whose providers were randomized to the registry (n=32 PCPs, 126 patients) compared to usual care (n=64 PCPs, 313 patients) experienced a 1.7-fold greater increase in the odds of albuminuria measurement after 6 months (95% CI, 0.97-3.21) and a 2.1-fold greater increase at 9 months (1.12-3.87). There were trends towards improved BP control among those in the registry arm but no difference in ACEi/ARB prescription over time was noted among the groups (p> 0.1 for both interaction terms).

Conclusion: Preliminary data suggest that a CKD registry for population health management can improve processes of care for patients with CKD in a safety net setting. Longer follow-up is needed to determine the impact of the registry on clinical outcomes, such as BP and albuminuria.

Learning Areas:

Chronic disease management and prevention
Communication and informatics
Diversity and culture
Epidemiology
Public health or related research

Learning Objectives:
Describe the public health burden of chronic kidney disease in the United States. Assess the impact of a primary care chronic kidney disease (CKD) registry on delivery of guideline concordant CKD care. Identify challenges of implementing practical clinical trials in a safety-net primary care clinic.

Keyword(s): Chronic Disease Management and Care, Vulnerable Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the project coordinator for the Kidney Awareness Registry and Education (KARE), a federally funded study and have been involved in several studies with UCSF as well as with UCD. My research interests include health care disparities, chronic disease, language barriers, and also educating and empowering vulnerable populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4375.0: Health Informatics Information Technology (HIIT) Section Poster Session #2