To determine whether the use of educational sessions and computerized clinical reminders can
improve primary care doctors' delivery of care to CKD patients compared to educational
sessions alone. Hypothesis: Clinical reminders will improve the care delivered to CKD
Literature supports that most chronic kidney disease (CKD) patients are cared for by primary
care physicians (PCP) without the help of a kidney specialist. Many of these patients fail
to achieve targeted outcomes and late referral to a nephrologist has been associated with an
increased risk of death. Automated computerized clinical reminders have been shown to
improve physician compliance with recommended guidelines in other settings.
Aims: To determine if clinical reminders can help PCPs decrease the rate of late referrals,
improve urine albumin checks in CKD patients
Design: prospective randomized controlled, single-blinded study with additional historical
Methods: Two 20-minute teaching sessions aimed at all GIM PCPs in the UPMC clinic followed
by randomization of the eligible GIM providers to receive automated clinical reminders (CR)
for their CKD stage 3b-5 patients versus routine care.
Outcomes: Using a database search, individuals with an eGFR<45ml/min/1.73m2 (not seen by a
nephrologist) will have data collected on: PCP referral to a nephrologist, urinary albumin
(or protein) quantification in the past year, PCP recognition of patients with
eGFR<45ml/min, ACE/ARB usage.
- For PCPs: all GIM attending physicians with a weekly continuity clinic.
- For patients: >= 18 years-old with an eGFR<45ml/min/1.73m2 being seen in the UPMC GIM
clinic by a faculty member during the 10-month intervention period
- for PCPs: imminent plans to leave the department
- patients with a renal transplant, on any form of dialysis, or with a previous