Sue & Bill Gross School of Nursing

Background: Diabetic kidney disease (DKD) is the leading cause of end stage renal disease (ESRD) in the United States and affects one-third of adults with diabetes. Albuminuria is a critical biomarker of renal and cardiovascular morbidity, including coronary artery disease, stroke, heart failure, arrhythmias, and microvascular complications. Early detection through estimated glomerular filtration rate (eGFR) and urine albumin–creatinine ratio (uACR) testing enables timely interventions, improved chronic disease management, and better long-term outcomes. Local Problem: At the project site, only 80% of eligible adults with diabetes completed annual kidney health evaluations, below the NCQA HEDIS KED national benchmark of 90%. Contributing barriers included inconsistent ordering practices, workflow inefficiencies, and underutilized point-of-care testing. The absence of a standardized system-based process limited screening consistency and early disease identification. Objective: This quality improvement initiative’s objective was to evaluate how the implementation of a standardized electronic health records (EHR) “Diabetes Workup” order set, adopting a new office workflow, and use of a provider decision-support flowchart versus standard practice had effect on uACR screening compliance rates over 16 weeks for adult patients with diabetes mellitus in an outpatient clinic. The primary goal was to achieve a 10% increase in KED HEDIS screening compliance compared to the previous year. Methods: This 16-week pre-post albuminuria quality improvement project was conducted in a primary care clinic in Orange County, California. Participants included three primary care providers and an interprofessional team of nurses, medical assistants, and quality staff. Data was collected tracked and collected by the organization’s quality team using COZEVA quality reports. Results: After the 13-week implementation period, KED performance rates improved from 80.24% in 2024 to 87.43% in 2025, nearly reaching the project goal of a 10% increase. uACR screening rates among 250 eligible patients showed an upward trend, particularly in December 2025 and January 2026 of 90.74% and 92.50% respectively. The provider knowledge of frequency of screening and antiproteinuric therapy remained unchanged in pre-and-post intervention, with baseline at 100%. Conclusion: This DNP-led quality improvement initiative demonstrated that small, scalable interventions are effective in improving evidence-based DKD screening practices.