Effect of Monthly Directed Reviews of a CKD Dashboard on Evidence-Based Management in a Nephrology Fellow Clinic

Background: Gaps in guideline-based CKD care must be quantified to improve outcomes. Identifying patients who may benefit is key to comprehensive management. A clinical dashboard can reveal prescribing patterns and guideline gaps, ultimately enhancing care. Methods: In collaboration with IT, we developed a CKD dashboard using data from Epic, integrated into Tableau. It updates automatically and was implemented in our Nephrology Fellow Clinic, covering 789 patients over 3 years, with ongoing additions. Each of 10 fellows is assigned a panel and completes monthly guideline-based questions during the intervention. First, a survey assessed pre-engagement with the dashboard. Three subsequent surveys examined evidence-based CKD parameters, SGLT2 inhibitor use, renin-angiotensin system inhibitor (RASi) use, and transplant referral. Cutoffs included a UACR more than 200 mg/g for SGLT2i and RASi use; eGFR less than 20% and 2-yrkidney failure risk equation (KFRE) more than 40% for transplant referral. Fellows reviewed their panels to identify patients not receiving evidence-based care, documenting reasons for non-receipt. No patient identifiers were collected. Surveys were analyzed to determine usage rates, treatment barriers, and prevalence of contraindications. We hypothesized that monthly dashboard use would improve guideline-based care. Results: Before the monthly directed intervention, Fellows reported minimal interaction with dashboard. During the intervention, crude data showed 42% of patients with UACR >200 mg/g were on SGLT2i, 83% on RASi, and 52% of those with eGFR <20 ml/min had transplant referrals. After excluding contraindications, rates rose to 62% (SGLT2i), 93% (RASi), and 71% (transplant). Excluding additional factors (patient left clinic, patient preference, or treating underlying cause first), rates reached 84%, 97%, and 96%, respectively. Following dashboard-guided monthly reviews, fellows planned to initiate SGLT2i in 29 patients, RASi in 6, and refer 4 for transplant, targeting 100% adherence across all metrics. Conclusion: The CKD dashboard provided a quantifiable approach to quality improvement by identifying gaps in guideline-directed care. Individualized patient panel analysis enabled targeted interventions and referrals, enhancing adherence to evidence-based management strategies.