Value of Implementing Quality Metrics in Outpatient Nephrology Care

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Value of Implementing Quality Metrics in Outpatient Nephrology Care

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Co-author 1

Carmen Elena Cervantes ccervan2@jhmi.edu Johns Hopkins University Medicine Baltimore United States *

Co-author 2

Heather Thiessen Philbrook heather.philbrook@jhu.edu Johns Hopkins University Medicine Baltimore United States -

Co-author 3

Jack Bitzel jbitzel1@jh.edu Johns Hopkins University Medicine Baltimore United States -

Co-author 4

Nityasree Srialluri nsriall1@jh.edu Johns Hopkins University Medicine Baltimore United States -

Co-author 5

Chirag Parikh chirag.parikh@jhmi.edu Johns Hopkins University Medicine Baltimore United States -

Co-author 6

Bernard Jaar bjaar@jhmi.edu Johns Hopkins University Medicine Baltimore United States -

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Introduction

Chronic Kidney Disease (CKD) is linked to a high risk of cardiovascular events and kidney failure. We aimed to establish quality metrics and implement an intervention to address care gaps in our nephrology clinic.

Methods

Using data from the Kidney Precision Medicine Center of Excellence (KPMCOE), we identified adults with at least one outpatient nephrology visit at Johns Hopkins in quarter (Q)1 2025. Patients were ages 18–85, without kidney transplant, and met CKD criteria based on eGFR ≤60 mL/min/1.73m² and/or UACR >30 mg/g, or equivalent urine labs. Quality measures included blood pressure (BP) <130/80 mmHg, UACR within the past year, and use of ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), SGLT2 inhibitors (SGLT2i), and GLP-1 receptor agonists (GLP-1 RA) for patients with UACR >300 mg/g. Based on gaps, we launched a Best Practice Alert (BPA) to support prescribing (Table 1).

Results

Table 1. QI metrics

Among 2,507 patients, BP control declined with CKD severity (58% in CKD 1 vs 33% in CKD 5). UACR testing averaged 90% across stages. Use of kidney protective therapies increased with disease severity with ACEi/ARB, SGLT2i, and GLP-1 RA in CKD 3b at 74%, 41%, and 11%; compared to 56%, 40%, and 12% in CKD4, respectively. Compared to national benchmarks (55% ACEi/ARB, 11.9% SGLT2i), our clinic outperformed, though treatment gaps remained (Table 1). The BPA was deployed on April 1, 2025; outcomes are being evaluated.

Conclusion

Benchmarking quality metrics can identify care gaps and a BPA can be a critical tool to address them and improve CKD care.

Kewords