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Impact of automated reporting of estimated glomerular filtration rate in the veterans health administration.

Publication ,  Journal Article
Wang, V; Hammill, BG; Maciejewski, ML; Hall, RK; Scoyoc, LV; Garg, AX; Jain, AK; Patel, UD
Published in: Med Care
February 2015

BACKGROUND: Early detection and treatment of chronic kidney disease (CKD) is important for slowing progression to renal failure and preventing cardiovascular events, but CKD is often not recognized and patients are referred to nephrologists too late for timely management. Automated laboratory reporting of estimated glomerular filtration rate (eGFR) has been introduced in many health systems to improve CKD recognition, but its impact on large, US-based health systems remains unclear. RESEARCH DESIGN: Retrospective time-series study examined change in renal care services and CKD recognition across VA health care system facilities in 2000-2009. Hierarchical generalized linear models were used to estimate immediate and long-term impacts of eGFR reporting across facilities on monthly rates of outpatient CKD diagnoses, utilization of CKD diagnostic tests (urine microalbumin and kidney ultrasound), and outpatient nephrology visits. RESULTS: Rates of CKD recognition through diagnoses in patient medical records changed an average of 11.4 additional diagnosed patients per 10,000 in the general outpatient population per month, with sustained long-term increases in CKD diagnoses (P<0.001). Diagnostic microalbumin and kidney ultrasound testing increased significantly, with long-term increases in microalbumin testing (P<0.001) and short-term increases in kidney ultrasound (P=0.01-0.04) rates across the VHA. There was no significant change in nephrology consultation rates. CONCLUSIONS: Automated eGFR reporting was associated with moderate system-level improvements in documentation of CKD diagnoses and use of diagnostic tests, but had no impact on nephrology consultation. To effectively reduce the large burden of disease and its associated complications, further strategies are needed to identify and provide timely treatment to those with CKD.

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Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

February 2015

Volume

53

Issue

2

Start / End Page

177 / 183

Location

United States

Related Subject Headings

  • Young Adult
  • Veterans Health
  • United States Department of Veterans Affairs
  • United States
  • Time Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Predictive Value of Tests
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wang, V., Hammill, B. G., Maciejewski, M. L., Hall, R. K., Scoyoc, L. V., Garg, A. X., … Patel, U. D. (2015). Impact of automated reporting of estimated glomerular filtration rate in the veterans health administration. Med Care, 53(2), 177–183. https://doi.org/10.1097/MLR.0000000000000275
Wang, Virginia, Bradley G. Hammill, Matthew L. Maciejewski, Rasheeda K. Hall, Lynn Van Scoyoc, Amit X. Garg, Arsh K. Jain, and Uptal D. Patel. “Impact of automated reporting of estimated glomerular filtration rate in the veterans health administration.Med Care 53, no. 2 (February 2015): 177–83. https://doi.org/10.1097/MLR.0000000000000275.
Wang V, Hammill BG, Maciejewski ML, Hall RK, Scoyoc LV, Garg AX, et al. Impact of automated reporting of estimated glomerular filtration rate in the veterans health administration. Med Care. 2015 Feb;53(2):177–83.
Wang, Virginia, et al. “Impact of automated reporting of estimated glomerular filtration rate in the veterans health administration.Med Care, vol. 53, no. 2, Feb. 2015, pp. 177–83. Pubmed, doi:10.1097/MLR.0000000000000275.
Wang V, Hammill BG, Maciejewski ML, Hall RK, Scoyoc LV, Garg AX, Jain AK, Patel UD. Impact of automated reporting of estimated glomerular filtration rate in the veterans health administration. Med Care. 2015 Feb;53(2):177–183.

Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

February 2015

Volume

53

Issue

2

Start / End Page

177 / 183

Location

United States

Related Subject Headings

  • Young Adult
  • Veterans Health
  • United States Department of Veterans Affairs
  • United States
  • Time Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Predictive Value of Tests
  • Middle Aged
  • Male