July 21, 2026
Article written by: Megan Schultz, MPH and Carolyn Koenig, MD
1 in 3 adults are at risk for chronic kidney disease (CKD), with diabetes and hypertension being the leading risk factors.1 Since it is asymptomatic at onset, only routine laboratory screening can identify CKD to prevent progression, reduce associated cardiovascular events, and avert end-stage kidney disease.2,3 Despite guideline recommendations for annual assessment in high risk populations, significant gaps remain in urine albumin-creatinine ratio (uACR) testing - one of the earliest predictors of kidney damage.4
To evaluate and optimize CKD care through early intervention, the National Kidney Foundation (NKF) developed the CKD Learning Collaborative - a quality improvement initiative that equips multidisciplinary teams with education, workflow redesign strategies, and clinical decision support (CDS) tools to appropriately identify and diagnose people living with CKD. In 2024, Mercy – one of the largest U.S. health systems with over 700 physician and outpatient clinics in Arkansas, Kansas, Missouri, & Oklahoma - partnered with NKF to launch this upstream model with recurring education across two pilot clinics and systemwide electronic health record enhancements in Epic. Leaders from primary care, population health, nephrology, and palliative care across Mercy ministry evaluated data to inform process improvements, tool enhancements, and educational opportunities for CKD screening and management.
Complemented by physician leaders sharing key tactics with primary care providers at clinic section meetings, these strategies included:
- CKD Our Practice Alerts (OPAs) to support pre-visit planning in providing easy access to common orders for evaluation and management
- CKD screening prompt to order eGFR + uACR testing (Kidney Profile) for at-risk patients living with diabetes and/or hypertension
- Confirmatory testing prompt to order repeat eGFR testing when initial test is abnormal to confirm and accurately determine diagnosis of CKD
- CKD evaluation prompt to order testing and a renal ultrasound (once in a lifetime) for patients with diagnosed CKD who are missing one or more recommended labs within the appropriate timeframe
- Ambulatory order set for CKD (xOrder) to drive appropriate evaluation, treatment, and referral decisions (if needed) for patients living with diagnosed CKD
- Offers easily clickable orders in the patient chart for labs and medications using guideline recommendations based on the relevant CKD stage
- Pulls in patient level data alongside evidence-based practices to guide clinical decision making
- Includes the CKD Heatmap resource and a streamlined referral pathway to medical nutrition therapy
- NKF patient educational handouts available as an easy add option for dissemination in the patient after visit or discharge summary
- Primary care-wide Grand Rounds presentations reaching over 60 participants
Key Outcomes Emerged from the Partnership
Following the learning collaborative deployment, positive impacts from 2023 to 2025 include:
- More than 92% increase in uACR screening among patients with hypertension --- from 21.45% to 41.37%
- More than 58% increase in uACR screening among the diagnosed CKD population --- from 31.99% to 50.65%
- Nearly 18% increase in uACR screening among patients with diabetes --- from 57.26% to 67.52%
- Provider CDS Tool Engagement: 432 uses of the ambulatory order set for CKD from February 2024-February 2025
What’s Next for the Collaborative
Mercy will be building upon the CKD Learning Collaborative efforts in the year ahead with a focus on how to increase utilization of CDS tools, particularly tools to improve CKD treatment and management. The leadership team includes new champions to continue to inform best practices for increasing adoption and consistent use of the tools within routine primary care processes. The hope is to include the project data metrics in an ambulatory care dashboard to benchmark clinic and provider level performance for ongoing gap closure. Looking ahead, the team will evaluate how improvements in CKD screening can more effectively yield improvements in appropriate CKD diagnosis/documentation and guideline directed medical therapy utilization.
This project was led by Mercy staff members, Carolyn Koenig, MD, Kerri Lenihan, MPH, Brian Ringhofer, MD, & Sameer Kirtane, MD, who worked alongside NKF Population Health Partnership Director Megan Schultz, MPH.
