University of Vermont

College of Medicine

Vermont Medicine Magazine

MacLean and Colleagues’ Study Identifies Barriers to Screening for Kidney Damage in Diabetes Patients

Charles MacLean, M.D., professor of medicine and associate dean for primary care
Charles MacLean, M.D., professor of medicine and associate dean for primary care

A study recently published in the American Society for Clinical Pathology Lab Medicine Journal found that confusingly similar test names and test result ranges, as well as design errors in test ordering systems, are among the leading factors contributing to substantial, undetected long-term failure to correctly screen for kidney damage in patients with diabetes. The research was led by University of Vermont College of Medicine researchers Charles MacLean, M.D., professor of medicine and associate dean for primary care, and Benjamin Littenberg, M.D., professor of medicine and director of general internal medicine research.

Both MacLean and Littenberg conducted the research in their respective roles as senior medical advisor and chief medical officer at Burlington. Vt.-based Patient Engagement Systems® (PES), a healthcare patient-physician engagement and analytics company that supported the research. PES Operations Director Michael MacCaskey co-led the study.

The Lab Medicine study focused on proteinuria testing – a laboratory test to determine kidney damage. According to the American Diabetes Association, the kidneys play an important and critical role in filtering the waste products created from the digestion of protein. The millions of tiny blood vessels in the kidneys feature tiny holes that allow them to act as filters and remove these waste products, which eventually become part of urine. Diabetes – and more specifically, high levels of blood sugar – can damage this system and cause the kidneys to filter too much blood. Over time, this extra work causes these filters to leak and useful protein is lost in the urine.

From 2009 to 2010, Littenberg and his PES colleagues installed the PES diabetes clinical decision support system in two large primary care organizations and provided reminders to clinicians and patients regarding overdue laboratory testing.

“The system was previously developed by UVM and proven effective by a National Institutes of Health grant,” says Littenberg. “After installing the system in these two practices, rates of guideline-concordant proteinuria testing were lower than anticipated. Investigation of the underlying causes showed, among other issues, problems with test ordering systems that lead to systematic ordering of the incorrect test.”

Littenberg adds that “These tests are essential to detecting early kidney damage and preventing renal failure. In many cases, the labs were reporting a different test than what the providers thought they were getting – a very dangerous situation for patient safety. The costs of the incorrect tests were adding to the skyrocketing expenditures for medical care.”

Introduction of the registry-based Patient Engagement System led to detection of system-wide problems and monitoring the effectiveness of solutions. Correct proteinuria testing improved from 42.5 percent to 64.6 percent (P <0.001).

“This is an example of how a system to improve patient engagement can also function as a way to improve quality across a whole system of health care, improving outcomes and lowering costs,” says MacLean.

Learn more about PES.

This article was adapted from a press release produced for PES by Frank Public Relations Worldwide.