Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Nancy R. Kloha

Clinical Mentor

Dr. Tamara Wellman

Committee Member

Dr. Kathy Wheeler

Abstract

Purpose: The purpose of this study was to evaluate provider adherence to the ADA’s recommendation for an annual screening urinary albumin excretion level to check for the presence of microalbuminuria. A secondary objective was to assess for adequate treatment (i.e. ACE inhibitor or ARB prescription) in those patients with microalbuminuria present.

Methods: A retrospective chart review was conducted on 60 randomly selected patients seen within a primary care practice in an urban university setting between January 1st, 2014 and December 31st, 2014. Inclusion criteria included age ≥ 18 years and an active diagnosis of type 2 DM as evidenced by ICD codes 250.00-250.93. Data collected included age, gender, ethnicity, marital status, insurance type, BMI, tobacco use status, presence or absence of a urinary albumin excretion level collected within the specified timeframe, and presence or absence of an active ACE inhibitor/ARB prescription. A database of 972 qualifying patients was provided by the university’s Division of Biomedical Informatics and 60 patients were randomly sampled from this database utilizing a random number generator.

Results: The retrospective chart review demonstrated that only 1 out of the 60 charts reviewed had received screening for microalbuminuria within the previous calendar year, as recommended by the national guidelines.

Conclusion: Increasing urinary albumin excretion rate screening is essential in early recognition and management of renal complications in patients with type 2 DM. Current rates in many practice settings appear to be suboptimal and there exists an opportunity for quality improvement and identifying strategies for improving screening rates.

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