Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD)

∙ CDS helps focus provider attention on CKD

∙ Perception by users that CDS improves care

∙ Disagreement about CKD guidelines

∙ Confusion about CKD guidelines

∙ Concerns about data validity

∙ Patients comanaged by nephrologists

∙ Lack of awareness of CDS tools

∙ Practice-wide prioritization of identifying patients with CKD

∙ In-office urine collection and/or albumin testing

∙ Standing orders for laboratory tests

∙ Patient registry used by staff for patient outreach

∙ Staff turnover

∙ Competing obligations (other incentive programs)

∙ Failure to fully implement standing orders

∙ CDS tools customized to workflow of practices by research team during site visits

∙ Research team able to troubleshoot CDS at site visits

∙ Research team demonstrated use of patient registry during site visits

∙ CDS tools required “extra clicks”

∙ Risk assessment tool did not always work

∙ Reports and tools did not capture labs ordered by specialists

∙ Use of registry required re-identifying patients

∙ Patient education about CKD (including educational handouts)

∙ Changing patients' expectations to adhere to urine testing

∙ Concern about patients seeing diagnosis of CKD

∙ Concern about overdiagnosis of CKD