RAndomized EHR-based Prescribing to Improve Disease-modifying Therapies for Cardio-Kidney-Metabolic Care (RAPID-CKM)

The goal of this pragmatic randomized clinical trial is to determine whether an Epic-based clinician notification increases initiation of guideline-directed cardio-kidney-metabolic (CKM) therapies in adults with type 2 diabetes and confirmed albuminuria. The main question it aims to answer is: • Does an Epic clinician notification improve initiation of guideline-directed CKM therapies compared with usual care? Researchers will compare an Epic in-basket clinician notification strategy with usual care. In the intervention arm, the treating clinician will receive an Epic notification identifying confirmed albuminuria and potential eligibility for guideline-directed CKM therapies using existing electronic health record (EHR) data. Participants in the usual care arm will receive standard clinical care without notification.

Inclusion Criteria * Adults aged ≥18 years * Diagnosis of type 2 diabetes mellitus * Receiving outpatient care within Baylor Scott \& White Health * At least 1 outpatient encounter within the preceding 12 months * Confirmed albuminuria (UACR \>30 mg/g) * Eligible for one or more guideline-directed CKM therapies based on - prespecified clinical criteria and EHR review Exclusion Criteria: * Type 1 diabetes mellitus * Contraindication or documented intolerance to all eligible guideline-directed CKM therapies * Advanced kidney dysfunction below recommended initiation thresholds for SGLT2i or finerenone * Hyperkalemia or elevated baseline serum potassium precluding safe therapy initiation * Contraindicated drug interactions (e.g., strong CYP3A inhibitors with finerenone) * Other guideline- or labeling-based contraindications to therapy initiation