Grant: Partnerships for Health System Improvement (PHSI)

Chronic kidney disease (CKD) is common, affecting almost 10% of all Canadian adults.However many patients with CKD do not receive optimal care. This may be because they have a number of other health conditions, and their CKD is not recognized, or it may be due to the complexity in the care they require. New clinical practice guidelines are being published to guide management of patients with CKD. Since the majority of patients with CKD (95%) are managed by primary care physicians, they will be the target for these guidelines. To help facilitate the uptake of the evidence in clinical practice by primary care physicians, the guidelines will be summarized in the form of a clinical pathway. The purpose of our proposed project is to implement and evaluate this clinical pathway for CKD in primary care. Specifically we will: 1) assess patient, provider and health system barriers and facilitators to uptake of the clinical pathway for CKD. 2) determine if the clinical pathway improves care for patients with CKD by doing an observational study (pre-post clinical pathway implementation), as well as a randomized trial (randomizing physician practices to electronic reminder and clinical decision support system to facilitate completion of a care plan for CKD). We will evaluate the impact of the clinical pathway using process of care outcomes (assessment of proteinuria; nephrology referral; completion of CACP), using our chronic disease laboratory (administrative and lab data for all Alberta health regions). This innovative work builds on extensive background work and has substantial potential to improve the quality and efficiency of care for patients with CKD. Our proposal is a novel collaboration between researchers, primary care and laboratory physic