Advanced CKD Patient Management Toolkit Assessment Tools ...



The Assessment Tool: Patient Identification is developed to give you a quick view of your current practices related to identifying and referring patients with advanced Chronic Kidney Disease (CKD). It is simple and can be performed by your office nurse or assistant with the help of the “Helpful Hints for Chart Abstractors” provided at the end of this section.

It is possible that you may not be aware of the issues related to identification and referral of advanced CKD patients. A quick internal review of 10 patient charts using this tool could reveal the extent of the problem.

Pointers for effective use of this tool:

• Once a patient has been identified as being in CKD stages 4/5, you can flag the exterior of the patient’s medical records chart with a CKD Chart Flag/Sticker (see toolkit, p. 79); flagged records can then be randomly selected for this assessment.

• The instructions for performing this assessment are on the following page. You can enter the data on the paper forms provided or, if you prefer, you may use the Excel spreadsheet (on the enclosed CD-ROM) for both data entry and analysis.

• The results (“rates”) that you calculate after completing the worksheet will provide you with an estimate of the extent to which advanced CKD patients in your practice are appropriately identified and referred.

• Results from this assessment, when compared to those from the Evaluation Tool, will provide a measure of your performance-improvement efforts.

• It is possible to customize this tool. For example, lab values/ranges can be altered. Values provided on the “master” represent those identified as best practices by the RPA Guideline working group.

Note that the Assessment Tool: Patient Identification is separate from the Assessment Tool: Patient Management. This latter tool is intended for clinics that wish to evaluate their performance with regard to ongoing patient management.

INSTRUCTIONS

1. Review patient problem lists or encounter sheets to select 10 patients in your practice who:

• you have followed for the past year

• have diabetes(

• are over 50 years of age, and

• have BP over 140/90 or are taking antihypertensive medication

2. Review the charts for each identified patient and record the data on the Analysis Sheet provided.

3. Calculate the rates following directions provided on the sheet

PATIENT IDENTIFICATION ANALYSIS SHEET

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Helpful Hints for Chart Abstractors

• Antihypertensive Medications—Medications prescribed in several different forms and available under a variety of different generic and brand names. Consult your physician for a list of antihypertensive medications s/he commonly prescribes.

• Creatinine—Serum creatinine values can be obtained from lab reports. Take care not to confuse urine and serum creatinine reports.

• Diabetes—The American Diabetes Association defines diabetes as:

– symptoms of diabetes and a casual plasma glucose

– >200 mg/dL, or

– fasting plasma glucose >126 mg/dL, or 2-hour plasma glucose >200 mg/dL during an oral glucose tolerance test (OGTT)

• GFR—Glomerular filtration rate is an estimate of kidney function. The value can be provided by the laboratory on the lab report, or calculated by the provider using a mathematical equation (MDRD) or a paper slide rule or computer. Units are typically expressed as mL/min/1.73m2 or abbreviated as mL/min.

• Multiple Values—If multiple values are found for GFR, blood test results, or blood pressure readings, use the most recent value available. Results should be within the past 1 year.

• Ordered—If the physician’s order or note says that a creatinine has been ordered, record this as a “yes” on this form, whether or not a creatinine result is recorded.

• Referral—Physician request to have patient see a nephrologist. Information is commonly found in a progress note or consult letter from a nephrologist. Check with physician to see how s/he would define and record referral to a nephrologist. Obtain a list from your physician of the names of frequently consulted nephrologists.(

* For definitions, use the terms defined in “Helpful Hints for Chart Abstractors.”

* Data for 10 patients can be entered in this sheet for identification of problem areas. This rate can be compared with corresponding post-implementation rates 6 months after implementation in order to assess the impact of implementation. Use data from the shaded row for this purpose.

Please note: Definitions of the terms in this handout pertain to the context in which they are used for these evaluation tools. Please consult with your physician prior to using the evaluation tools or these definitions.

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