title: Kaiser Permanente Creatinine Safety Program: A Mechanism to Ensure Widespread Detection and Care for Chronic Kidney Disease.
abstract: BACKGROUND
  Chronic kidney disease is highly prevalent but is challenging to diagnose because of the need to establish chronicity. Within the current healthcare environment, a single abnormal creatinine measurement often can go without a follow-up, which can lead to missed diagnoses or diagnostic errors. The Kaiser Permanente Southern California creatinine safety program (the Creatinine SureNet) was created to help ensure that all single abnormal creatinine results had a follow-up evaluation.
  
  
  METHODS
  In the period February 1, 2010, to March 1, 2014, the electronic health records were used to capture individuals with single abnormal creatinine results that went >90 days without a repeat measurement. A coordinated effort among a centralized regional nurse and providers was used to communicate with patients and order a repeat creatinine measurement.
  
  
  RESULTS
  A total of 12,396 individuals were identified (84% ambulatory care encounters). A total of 6981 individuals (52%) followed up with a repeat measurement. Female patients, non-Hispanic whites, and older individuals were more likely to obtain a repeat measurement. Subsequently, 3668 individuals had chronic kidney disease confirmed. Within 6 months, 1550 patients had chart documentation of their chronic kidney disease and 336 patients had a nephrology consultation.
  
  
  CONCLUSIONS
  The ambulatory care environment, given its high volume and various prioritizations, is an under-recognized area where diagnostic errors are not uncommon and failure to follow up on abnormal test results can occur routinely. The Kaiser Permanente Southern California Creatinine SureNet program leverages the electronic health records and its multidisciplinary resources in an effort to ensure that patients with potential chronic kidney disease are identified and managed properly.
authors.affiliation: Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif. Electronic address: John.j.sim@kp.org.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sim
authors.affiliation: Regional Quality and Clinical Analysis, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Rutkowski
authors.affiliation: Regional Quality and Clinical Analysis, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena.
authors.forename: David C
authors.initials: DC
authors.lastname: Selevan
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Michael
authors.initials: M
authors.lastname: Batech
authors.affiliation: Regional Quality and Clinical Analysis, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena.
authors.forename: Royann
authors.initials: R
authors.lastname: Timmins
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Slezak
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.affiliation: Regional Quality and Clinical Analysis, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kanter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D015415:Biomarkers / Q000097:blood; D002140:California; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003404:Creatinine / Q000097:blood*; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Chronic kidney disease; Diagnostic errors; Health outcomes; Quality and safety program