ArticleClinical journal of the American Society of Nephrology : CJASN2014
Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 17 citations in OpenAlex.
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- Lab-based and diagnosis-based chronic kidney disease recognition and staging concordance.BMC nephrology · 2019Article
- Comparison of automated and retrospectively calculated estimated glomerular filtration rate in electronic health record data.BMC nephrology · 2018Article
- Data and knowledge standards for learning health: A population management example using chronic kidney disease.Learning health systems · 2018Article
- Patterns of primary care utilization before and after living kidney donation.Clinical transplantation · 2017Article
- Early recognition of multiple sclerosis using natural language processing of the electronic health record.BMC medical informatics and decision making · 2017Article
- Risk prediction to inform surveillance of chronic kidney disease in the US Healthcare Safety Net: a cohort study.BMC nephrology · 2016Article
- Validation of the Korean coefficient for the modification of diet in renal disease study equation.The Korean journal of internal medicine · 2016Article
- Clinical implications of the CKD epidemiology collaboration (CKD-EPI) equation compared with the modification of diet in renal disease (MDRD) study equation for the estimation of renal dysfunction in patients with cardiovascular disease.Internal and emergency medicine · 2015Article
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
BACKGROUND AND
objectivesEarly detection of CKD is important for slowing progression to renal failure and preventing cardiovascular events. Automated laboratory reporting of estimated GFR (eGFR) has been introduced in many health systems to improve CKD recognition, but its effect in large, United States-based health systems remains unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using Veterans Affairs (VA) laboratory and administrative data, two nonoverlapping national cohorts of patients receiving care in VA medical centers before (n=66,323) and after (n=16,670) implementation of automated eGFR reporting between 2004 and 2010 were identified. Recognition was assessed by the presence of new CKD diagnostic codes, use of additional diagnostic testing, outpatient nephrology visits, or overall CKD recognition (receipt of at least one of these outcomes) for each patient during the 12-month period after their first eligible creatinine or eGFR laboratory result. Generalized estimating equations were used to assess change before and after automated eGFR reporting.
resultsOverall CKD recognition increased from 22.1% of veterans before eGFR reporting to 27.5% in the post-eGFR reporting period (odds ratio [OR], 1.19; 95% CI, 1.12 to 1.27; P<0.001). Higher overall CKD recognition was driven largely by increased documentation of CKD diagnosis codes in medical records (OR, 1.31; 95% CI, 1.21 to 1.41; P<0.001) and diagnostic testing for CKD (OR, 1.13; 95% CI, 1.03 to 1.24; P<0.01) rather than outpatient nephrology consultation. Automated eGFR reporting was not associated with greater CKD recognition among black or older patients (P=0.07).
conclusionsAutomated eGFR laboratory reporting improved documentation of CKD diagnoses but had no effect on nephrology consultation. These findings suggest that to advance CKD care, further strategies are needed to ensure appropriate follow-up evaluation to confirm and effectively evaluate CKD.
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