Managing Diabetes

Best Practices Can Lower “Multiplier Risks”

by Teddi Fine

Nearly 17 percent of U.S. adults are affected by chronic kidney disease (CKD), a significant underlying cause of cardiovascular disease in the United States. CKD also accounts for nearly 28 percent of Medicare expenditures. Adults with diabetes are at increased risk for both CKD and high blood pressure. Any one of these problems can be serious; together they exponentially raise the likelihood of cardiovascular and cerebrovascular morbidity and mortality.

The good news is that controlling high blood pressure can slow the progression of diabetes-related CKD and decrease the incidence of heart attack, stroke, and the progression to end-stage renal disease.

Unfortunately, best practices for diagnosing and managing chronic kidney disease and blood pressure often are not followed by primary care providers. A study by doctoral graduate Bernadette Thomas, DNP ’11, MPH, APRN, reports on the use of individualized action lists and electronic health record (EHR) technology to help boost provider adherence to best practices. [“Improving Blood Pressure Control Among Adults with CKD and Diabetes: Provider-focused Quality Improvement Using Electronic Health Records,” Advances in Chronic Kidney Disease, November 2011]

The study tracked 3,137 diabetic patients across 6,781 separate clinician visits. EHR-based scorecards and real-time feedback significantly increased doctor and nurse practitioner adherence to best practices in screening, diagnosis, and treatment.

“Using reminders and action lists helps keep evidence-based guidelines on a provider’s radar screen and increases our capacity to deliver quality chronic disease management,” Thomas notes.