Posters
A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States, with 37 million having chronic kidney disease. Unfortunately, despite guidelines recommendations from the American Diabetes Association and the Kidney Disease Improving Global Outcomes for diabetic nephropathy, screening with urine albumin-to-creatinine ratio (UACR) and annual estimated glomerular filtration rate (eGFR), there is still poor screening rates throughout the country. Our aim is to increase the screening for type 2 diabetic nephropathy in our GME Internal Medicine clinic.
Methods: Our group of 10 Internal Medicine residents and 2 faculty advisors conducted this project from July 2021 to April 2022. We used the electronic medical record (EMR) to determine the screening rates in patients with diabetes using UACR. Our interventions included resident education, adding reference range of UACR in the EMR, highlighting abnormal results of UACR in the EMR, and including UACR in the low-cost wellness laboratory order form. We calculated the probability ratio and attributable probability of being screened after the intervention and used a pre and post survey to assess resident knowledge. Analysis was performed with Stata version 17.0.
Results:We included 217 patients with diabetes from which90% identified as Hispanic. Comparing pre and post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The probability ratio for being screened before intervention was 1.6 (95%CI 1.2, 2.1; p=0.003). If screening only completed in the post-intervention period the probability ratio increased to 3.2 (95%CI 2.4, 4.3; p
Conclusion: Through education, EMR optimization and updates to the low-cost lab order form, our resident-led quality improvement project increased screening for diabetic nephropathy from 20.7% to 32.7%which reached our goal of 50% increase. We found the resident-led QI project to be feasible and effective even in an underinsured and high-risk Hispanic population.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Luu, Stephanie; Rivera, Jose A.; Zamora-Legoff, Victor; Huayanay Espinoza, Irma; Majzoub, Reham; Brar, Sumandeep; Aragon, Daniel; Baird, Andreina; Escobar, Cristina; Sanchez, Eric; Mondreti, Kalyana; and Lopez-Alvarenga, Juan Carlos, "A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population" (2023). Research Symposium. 116.
https://scholarworks.utrgv.edu/somrs/2022/posters/116
A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population
Background: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States, with 37 million having chronic kidney disease. Unfortunately, despite guidelines recommendations from the American Diabetes Association and the Kidney Disease Improving Global Outcomes for diabetic nephropathy, screening with urine albumin-to-creatinine ratio (UACR) and annual estimated glomerular filtration rate (eGFR), there is still poor screening rates throughout the country. Our aim is to increase the screening for type 2 diabetic nephropathy in our GME Internal Medicine clinic.
Methods: Our group of 10 Internal Medicine residents and 2 faculty advisors conducted this project from July 2021 to April 2022. We used the electronic medical record (EMR) to determine the screening rates in patients with diabetes using UACR. Our interventions included resident education, adding reference range of UACR in the EMR, highlighting abnormal results of UACR in the EMR, and including UACR in the low-cost wellness laboratory order form. We calculated the probability ratio and attributable probability of being screened after the intervention and used a pre and post survey to assess resident knowledge. Analysis was performed with Stata version 17.0.
Results:We included 217 patients with diabetes from which90% identified as Hispanic. Comparing pre and post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The probability ratio for being screened before intervention was 1.6 (95%CI 1.2, 2.1; p=0.003). If screening only completed in the post-intervention period the probability ratio increased to 3.2 (95%CI 2.4, 4.3; p
Conclusion: Through education, EMR optimization and updates to the low-cost lab order form, our resident-led quality improvement project increased screening for diabetic nephropathy from 20.7% to 32.7%which reached our goal of 50% increase. We found the resident-led QI project to be feasible and effective even in an underinsured and high-risk Hispanic population.