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Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration.

Publication ,  Journal Article
Wang, V; Maciejewski, ML; Hammill, BG; Hall, RK; Van Scoyoc, L; Garg, AX; Jain, AK; Patel, UD
Published in: Clin J Am Soc Nephrol
January 2014

BACKGROUND AND OBJECTIVES: Early 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. RESULTS: Overall 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). CONCLUSIONS: Automated 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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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

January 2014

Volume

9

Issue

1

Start / End Page

29 / 36

Location

United States

Related Subject Headings

  • Veterans Health
  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Time Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Referral and Consultation
  • Prognosis
  • Predictive Value of Tests
 

Citation

APA
Chicago
ICMJE
MLA
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Wang, V., Maciejewski, M. L., Hammill, B. G., Hall, R. K., Van Scoyoc, L., Garg, A. X., … Patel, U. D. (2014). Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration. Clin J Am Soc Nephrol, 9(1), 29–36. https://doi.org/10.2215/CJN.02490213
Wang, Virginia, Matthew L. Maciejewski, Bradley G. Hammill, Rasheeda K. Hall, Lynn Van Scoyoc, Amit X. Garg, Arsh K. Jain, and Uptal D. Patel. “Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration.Clin J Am Soc Nephrol 9, no. 1 (January 2014): 29–36. https://doi.org/10.2215/CJN.02490213.
Wang V, Maciejewski ML, Hammill BG, Hall RK, Van Scoyoc L, Garg AX, et al. Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration. Clin J Am Soc Nephrol. 2014 Jan;9(1):29–36.
Wang, Virginia, et al. “Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration.Clin J Am Soc Nephrol, vol. 9, no. 1, Jan. 2014, pp. 29–36. Pubmed, doi:10.2215/CJN.02490213.
Wang V, Maciejewski ML, Hammill BG, Hall RK, Van Scoyoc L, Garg AX, Jain AK, Patel UD. Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration. Clin J Am Soc Nephrol. 2014 Jan;9(1):29–36.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

January 2014

Volume

9

Issue

1

Start / End Page

29 / 36

Location

United States

Related Subject Headings

  • Veterans Health
  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Time Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Referral and Consultation
  • Prognosis
  • Predictive Value of Tests