Developing a CKD registry in primary care: provider attitudes and input

Abstract

Background: Chronic disease registries have been successful at promoting the delivery of guideline-concordant primary care for patients with diabetes and hypertension, but not for chronic kidney disease (CKD). To understand whether a registry could be designed to improve CKD management in primary care, we explored primary care provider attitudes about the benefits (or lack thereof) of a CKD registry compared with other chronic diseases and the key facilitators of successfully implementing a CKD registry in safety-net primary care.

Study design: Qualitative, using semistructured interviews.

Setting & participants: We conducted and recorded semistructured 1-hour interviews with medical directors and quality improvement champions from safety-net adult primary care clinics in San Francisco.

Analytic approach: Recordings were transcribed and analyzed using a grounded theory approach until thematic saturation was achieved.

Results: 20 primary care providers were interviewed. 4 themes relevant to the development of a successful CKD registry for safety-net primary care were identified: (1) provider beliefs that a CKD registry could aid in the delivery of team-based high-quality CKD care; (2) clinic workflow redesign and staffing are key facilitators to successful implementation of a CKD registry; (3) unique complexities of CKD, such as varying etiologies, may limit the use of a CKD registry by nonphysicians; and (4) a CKD registry is aligned with current primary care priorities and health care delivery strategies.

Limitations: Small sample size and reliance on clinician leaders within one health care delivery system.

Conclusions: A CKD registry directed at the entire health care team, with the functionality to track, standardize, and enhance CKD care through decision support, has the potential to improve the management of CKD in safety-net primary care settings. These data directly informed the development of a CKD registry in these settings in San Francisco.

Keywords: Chronic kidney disease (CKD) registry; chronic disease management; chronic kidney disease (CKD) awareness; decision support; guideline implementation; health information technology (IT); primary care; safety net.