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| AIM | MEASURE | CHANGE | |||
|---|---|---|---|---|---|
| Quality Dimension | Objective | Measure/Indicator | Planned improvement initiatives (Change Ideas) |
Process measures | Change ideas (2017/18) |
| Effective/ Population Health |
Improve the screening and identification of CKD for adult patients in primary healthcare teams in Ontario with a focus on patients at high risk | % of adult patients with eGFR >30 or urine ACR <60 in the EMR | Reminders to prompt primary care providers to assess the opportunity to screen. | 1. % of adult patients 18 years of age or older with a eGFR or urine ACR in the EMR | 1. EMR use for capturing identification of eligible patients capturing screening rates & capturing patients who refuse or are not ready for screening |
| % of adult patients with identified risk factor(s) with eGFR >30 or urine ACR <60 values in the EMR |
PROVIDER – EMR-Focused change ideas PATIENT – Patient decision-support-focused change ideas |
1. % of adult patients 18 years of age or older with identified risk factors such as diabetes 2. % of adult patients with identified risk factors such as diabetes with eGFR or Urine ACR value in the EMR |
1. EMR reminder/recall systems 2. Outreach to patients via Letters, Emails, Phone Calls, Focus Groups 3. Collaboration with Nephrology Early CKD team 4. Decision Support Aids |
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Vascular Health Primary Care Work Group
Last Updated: April 30, 2017