{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:59:11Z","timestamp":1790405951286,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gen and Family Med"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Annual urine testing using the urine albumin\u2010to\u2010creatinine ratio (UACR) or urine protein\u2010to\u2010creatinine ratio (UPCR) is recommended for diabetic kidney disease (DKD) screening, yet attainment in nonspecialist primary care in Japan remains approximately 20%, and evidence on whether audit\u2010and\u2010feedback can produce sustained improvement in this quality indicator (QI) is limited. We evaluated the impact of an audit\u2010and\u2010feedback intervention on urine testing QI attainment and its sustainability after active feedback ceased.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a single\u2010center before\u2010and\u2010after study at an urban primary care clinic in Tokyo. QI attainment was measured across ten rolling 12\u2010month windows. Three individualized feedback sessions delivered in 2024 each included physician\u2010level attainment rates and appointment\u2010based patient identification lists. Run chart analysis assessed process change, and a post\u2010intervention physician survey examined facilitators and barriers using the COM\u2010B framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The pre\u2010intervention median attainment was 18.6%. Following the intervention, attainment rose from 19.7% to 53.7%, an increase of 34.0 percentage points, and the shift rule was satisfied, with eight consecutive points (M3\u2013M10) exceeding the pre\u2010intervention median. At M9\u2013M10, outside the active intervention period, attainment was 56.5% (36.8 percentage points above baseline). Within\u2010physician analysis confirmed sustained improvement (Wilcoxon W\u2009=\u20097,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913). The survey identified patient identification lists as the key facilitator, with carry\u2010forward electronic medical record ordering and uncertainty about post\u2010test management as primary barriers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An audit\u2010and\u2010feedback intervention achieved substantial and sustained improvement in urine testing QI attainment in nonspecialist primary care. Patient identification lists may have facilitated initial improvement, while sustained attainment may reflect behavioral routinisation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jgf2.70162","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:49:08Z","timestamp":1786006148000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sustained Improvement in Urine Testing Quality Indicator Through an Audit\u2010and\u2010Feedback Intervention in Japanese Primary Care: A Before\u2010and\u2010After Study"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7435-5234","authenticated-orcid":false,"given":"Hiromitsu","family":"Yamashita","sequence":"first","affiliation":[{"name":"Kawakita Family Clinic Minamiasagaya  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Kawakita Family Clinic Minamiasagaya  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayoshi","family":"Shiota","sequence":"additional","affiliation":[{"name":"Kawakita Family Clinic Minamiasagaya  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc25-S011"},{"key":"e_1_2_13_3_1","volume-title":"CKD Clinical Practice Guide 2024: Management of Patients With Diabetes and CKD: Urine Albumin Measurement and Glycaemic Targets","author":"Japanese Society of Nephrology","year":"2024"},{"key":"e_1_2_13_4_1","volume-title":"Type 2 diabetes in adults: management. NICE Guideline NG28","author":"National Institute for Health and Care Excellence (NICE)","year":"2022"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-24-01926"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2012070718"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.05.013"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgf2.229"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-2715"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2023.10.005"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.05.029"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000620"},{"issue":"3","key":"e_1_2_13_13_1","article-title":"Audit and Feedback: Effects on Professional Practice and Healthcare Outcomes","volume":"3","author":"Ivers N.","year":"2025","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/20.210"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/893913"},{"issue":"9","key":"e_1_2_13_16_1","article-title":"Screening for Microalbuminuria in Patients With Type 2 Diabetes Is Incomplete in General Practice","volume":"59","author":"Knudsen S. 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