title: Screening for diabetic kidney disease in primary care for the underinsured: A quality improvement initiative.
abstract: OBJECTIVE
  Screening rates for DKD in primary care are low, even though diabetes accounts for 44% of all new kidney disease cases. The purpose of this project was to determine if a primary care team for the underinsured improved screening and diagnosis of diabetic kidney disease (DKD) after initiating a quality improvement (QI) process.
  
  
  METHODS
  A chart audit with feedback, provider education of clinical practice guidelines, and strategies from TeamSTEPPS™ were implemented with the inter-professional primary care team.
  
  
  RESULTS
  Pre/post-intervention chart audit analysis showed the frequency of ordering microalbumin increased from 50.3% (n=148) to 75% (n=148), and diagnosing DKD rose from 3.3% (n=10) to 10.7% (n=21) over three months (P=.000).
  
  
  CONCLUSIONS
  Implementing a QI process in underinsured primary care centers improved the compliance of proper screening and diagnosing DKD AND introduced inter-professional practice competencies and teamwork strategies not previously recognized at the centers.
authors.affiliation: College of Nursing, Michigan State University, East Lansing, MI. Electronic address: dellahc@msu.edu.
authors.forename: Della L
authors.initials: DL
authors.lastname: Hughes-Carter
authors.affiliation: College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN.
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Hoebeke
mesh_terms: D000328:Adult; D003928:Diabetic Nephropathies / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D011320:Primary Health Care; D058996:Quality Improvement
keywords: Chronic kidney disease; Diabetes; Diabetic kidney disease; Quality improvement; Screening; Underinsured