Bridging the gap of referral to nephrology care

Implementation of the Kidney Failure Risk Equation in a United States Nephrology Clinic

“…Implementation of high-yield guides providing education on appropriate interpretations and applications of the KFRE, designed for nephrology providers, non-nephrology providers, and patients, is an area of potential future research. It is plausible that through this education, providers and patients will better recognize the need for albuminuria testing, 10 which has historically been low. 17 , 18 , 19 …”

“…KFRE risk-based thresholds have been proposed as a method to guide several aspects of nephrology care. 5 , 6 , 7 , 8 , 9 , 10 Several studies have predicted that using KFRE scores as a criterion for nephrology referral will result in a reduction in unnecessary referrals, and an increase in earlier referrals for patients at high risk of progression to kidney failure. 5 , 20 , 21 , 22 In one care setting in Canada, KFRE scores dictate the urgency of nephrology referral.…”

“… 9 Some guidelines suggest referral to nephrology care when 5-year KFRE scores are >5%, and referral for dialysis access and/or transplantation when 2-year KFRE scores are >20% to 40%. 10 …”

Clinical Decision Support Tools in the Electronic Medical Record

“… 45 , 46 , 47 Because of the simplicity of the KFRE and accessibility of the variables included in the KFRE, it has previously been implemented into EMR systems to support both clinical practice and research on CDS tool integration. 38 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 Via its integration with EMR systems, KFRE can be automatically calculated, improving the identification of patients at risk of developing kidney failure and improving provider workflow. 45 , 46 , 47 , 49 , 52 , 53 , 55 , 57 , 60 , 61 Others 45 , 47 have suggested that incorporating automatic prompts into a KFRE CDS tool to encourage providers to order urinary albumin-to-creatinine ratio testing, which is not routinely collected, would improve the accuracy of KFRE and downstream patient outcomes.…”

“…A current barrier to using CDS tools is the requirement for manual data entry into calculation tools external to the EMR system. 45 , 47 , 52 , 55 , 57 , 61 If providers must manually transfer output results into their clinical charts and notes, this could arise as another barrier to using CDS tools. Further, if the results received from a CDS tool are complex, the time necessary for transferring the data into clinical charts or notes will likely prevent providers from using these tools further.…”