Medical management of patients with chronic kidney disease (CKD) is complex. To ensure providers at Cincinnati Children’s are doing the best possible job of following and managing these patients, the Division of Nephrology and Hypertension instituted a scoring system, or optimal outcome measure. Known as GRAB A BUCK (GRowth, Acidosis, Bone and mineral health, Anemia, Blood pressure/Ambulatory Blood pressure monitoring, Urine protein to creatinine ratios/Proteinuria, Cholesterol/weight/BMI, and overall Kidney Health), this tracking occurs in real time using registry-based data within the electronic medical record.

For each of 12 parameters, patients receive one process point if the condition has been appropriately monitored according to a CKD severity-based monitoring protocol, and then one outcome point if a patient is meeting this specific care goal. Checking every condition (12 process points) and finding improvement in every outcome (12 outcome points) results in a maximum total score of 24 points. GRAB A BUCK “progress toward goals” reports (see figure) are generated automatically for individual patients and providers prior to the medical visit. In addition, the GRAB A BUCK measure is followed for the entire CKD population through visit encounters each month, and trended over time. By following this data, we can better quantify how well we are doing in care delivery for both process and outcome measures, and find ways to improve the care we provide for these patients. For example, our vitamin D monitoring project was devised using population-based, GRAB A BUCK data.

Going back as far as February 2014, we have noted an overall improvement in the total GRAB A BUCK optimal outcome measure. On average, a Cincinnati Children’s CKD patient’s GRAB A BUCK process score has risen by about one point, to 11. The outcome score has shifted from about 7.5 to 8. In future, we hope to see both parameters continue to rise as we improve both our consistency and efficacy in CKD patient care.