Audit and Feedback Supporting New Guideline Implementation in Chronic Kidney Disease

Abstract

Background

Adults with Type 2 diabetes mellitus and chronic kidney disease experience higher risk for progression to end stage kidney disease, which negatively impacts health, increases medical costs, and decreases quality of life.

Objective

Determine if an audit and feedback intervention in a local nephrology clinic can increase provider adherence to a clinical practice guideline that supports the prescription of sodium glucose cotransporter-2 inhibitors to delay progression of chronic kidney disease.

Design

A pretest-posttest design was used to determine if an audit and feedback tool delivered to providers at 3-week intervals would increase provider adherence to the guideline recommendation over the course of 3 months. A clinical decision guide was provided to participants at the onset of the intervention with structured interviews accompanying the audit and feedback cycles.

Participants

English speaking physicians and advanced practice providers were recruited from a local nephrology outpatient clinic in the southeastern United States.

Measurements

To evaluate the significance of the intervention, a chi-square test was used to evaluate the change in prescribing of SGLT-2 inhibitors compared to the 3 months before the intervention. Logistic regression assisted with examining the relationship between the intervention and proportion of new SGLT-2 inhibitor prescriptions.

Results

In this setting, statistical analysis indicated that the intervention significantly increased prescription of SGLT-2 inhibitors in adults with Type 2 diabetes and chronic kidney disease.

Conclusion

The intervention significantly increased provider adherence to the clinical guideline. Additional implementation on a larger scale is warranted to validate findings and further investigate barriers to prescribing that were reported by participating providers.