INTRODUCTION:
Despite advances in diagnosis and management, disparities persist in the burden of end-stage kidney disease (ESKD); Black patients in the U.S. experience almost a 4X higher incidence than white patients.1 Among other reasons, this disparity stems from delayed identification of chronic kidney disease (CKD), hindering timely referral to nephrology specialists and medical interventions that improve outcomes. Structural racism has been implicated as a driver of these disparities. We present preliminary data on the implementation of a systems-level intervention that seeks to reduce inequities in access to CKD/ESKD treatment and care. Specifically, clinical practice alerts aimed at mitigating against implicit bias in referral practices, termed Our Practice Advisories (OPAs) were launched.

METHODS:
The OPAs were built into the Epic Electronic Medical Record in order to identify patients being discharged from the emergency department or hospital meeting one of two criteria: 1) eGFR <45 triggered a prompt for primary care referral; 2) eGFR <29 triggered a prompt to refer to nephrology.

RESULTS:
During the 11-week study period, the OPA fired 3,060 times (eGFR <29: n=520; eGFR <45: n=2,540). The affected population was predominantly Black (64%) and female (60%). Total provider response rate was 2% (n=53). Of those responding, Internal Medicine providers accounted for the majority (68%; n=36), followed by Critical Care (13%; n=7). Among the 53 responders, 40 (76%) completed a follow-up action. Key actions included: problem list updates, referral/order placement, and clinical integration. Thirty-six providers (68%) added CKD to the patient’s problem list, 36 (68%) placed a referral order, and 32 (60%) completed the combined action of adding the diagnosis while simultaneously placing a referral.

CONCLUSIONS:
We must educate providers on the utility of using OPAs. They serve as a tool for identifying patients who have diminished kidney functioning to expedite access to care, which may help reduce disparities.