CDS tools show promise in identification, treatment of chronic kidney disease


Clinical decision support (CDS) tools can help primary care providers flag, treat and monitor patients with chronic kidney disease (CKD), according to a new study in the Journal of the American Board of Family Medicine.

The incidences of CKD are increasing, and CKD can lead to other diseases, as well as death. The majority of patients with CKD are managed solely by primary care providers, but their adherence to clinical practice guidelines for the disease is “suboptimal,” according to the study's authors.

The researchers, from the Medical University of South Carolina, created several CDS tools to help primary care providers better assess and monitor for CKD. The CDS tools included a risk assessment tool, health maintenance protocols, a flow chart and a patient registry. The tools included prompts for lipid, urine albumin and other testing.

The researchers put the tools to use in 11 primary care practices and conducted a two-year demonstration study. 

They found that the tools showed “promise.” Use correlated with a “dramatic” increase in the number of at-risk patients who received testing for albuminuria, and as a result, hundreds more patients were identified who may benefit from early intervention. However, the tools didn’t help as much for other clinical quality measures.

The study also found barriers to using the tools effectively. While providers generally felt that use of these tools helped improve CKD management by focusing on CKD, there was occasional provider disagreement and confusion about the recommendations embedded in the tools. Some providers didn’t use the tools on a routine basis and forgot that they were available. There also were issues incorporating the tools into the clinicians’ workflow.

The researchers acknowledged that the barriers needed to be overcome, and that factors other than the tools themselves--such as care coordination--would affect any improvement in outcome.