Medical Research: What are the main findings of the study?
Dr. Mendu: Our study found that implementation of a chronic kidney disease (CKD) checklist, a tool that succinctly and clearly outlines CKD management guidelines, in a primary care clinic improved adherence to a number of significant management guidelines. We conducted a prospective study during a one year period among 13 primary care providers, four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD. Patients whose providers utilized a CKD checklist had higher rates of adherence to annual albuminuria testing, parathyroid hormone testing, phosphate testing, achieving a hemoglobin A1c target<7, documentation of avoidance of nonsteroidal anti-inflammatory drugs, use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker and vaccination for annual influenza and 5-year pneumococcus.
Medical Research: Were any of the findings unexpected?
Dr. Mendu: We were surprised that the CKD checklist had such a significant impact on adherence to multiple CKD management guidelines. Our findings were unchanged after adjusting for CKD stage, age and primary care provider assignment.
Medical Research: What should clinicians and patients take away from your report?
Dr. Mendu: Our findings show that implementation of a CKD checklist can significantly improve adherence to various CKD management guidelines and improve the delivery of CKD care. The CKD checklist can be incorporated into the electronic medical record as a form of clinical decision support as in this study or can be used by individual clinicians in their practice caring for chronic kidney disease patients.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Mendu: We recommend a randomized controlled study of the implementation of the CKD checklist in multiple primary care clinics over the course of several years. Our next steps involve designing and conducting such a study as a form of clinical decision support for primary care providers.
Implementation of a CKD Checklist for Primary Care Providers
Mallika L. Mendu, Louise I. Schneider, Ayal A. Aizer, Karandeep Singh, David E. Leaf, Thomas H. Lee, and Sushrut S. Waikar
CJASN CJN.01660214; published ahead of print August 18, 2014, doi:10.2215/CJN.01660214