Overview

The purpose of this study is to measure the evidence-based intervention's (EBIs) impact on patient safety and efficiency, to assess the EBIs implementation by measuring acceptability, appropriateness, cost, fidelity, penetration, and sustainability and to identify the facilitators and barriers that influence the degree of implementation of these EBIs.

Eligibility

Primary care providers' inclusion criteria:

• physicians, physicians assistants and advanced practice registered nurses in the 13 clinic locations of UTP are eligible if they care for patients at the time patient enrollment at their clinic begins
• agree to participate.

Patients' inclusion criteria are:

• hemoglobin result \< 10.8 for females and \< 12.5 for males with normal white cell count and platelet count (the prior hemoglobin results must have been in normal range, with a look-back period of two years)
• an eGFR value \< 60 (the prior eGFR results must have been in normal range, with a look-back range of two years)
• the matching creatinine results must also be in normal range
• not pregnant
• speak English or Spanish.