Document Detail


Chronic kidney disease identification in a high-risk urban population: does automated eGFR reporting make a difference?
MedLine Citation:
PMID:  22684427     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Whether automated estimated glomerular filtration rate (eGFR) reporting for patients is associated with improved provider recognition of chronic kidney disease (CKD), as measured by diagnostic coding of CKD in those with laboratory evidence of the disease, has not been explored in a poor, ethnically diverse, high-risk urban patient population. A retrospective cohort of 237 adult patients (≥ 20 years) with incident CKD (≥ 1 eGFR ≥ 60 ml/min/1.73 m(2), followed by ≥ 2 eGFRs <60 ml/min/1.73 m(2) ≥ 3 months apart)-pre- or post automated eGFR reporting-was identified within the San Francisco Department of Public Health Community Health Network (January 2005-July 2009). Patients were considered coded if any ICD-9-CM diagnostic codes for CKD (585.x), other kidney disease (580.x-581.x, 586.x), or diabetes (250.4) or hypertension (403.x, 404.x) CKD were present in the medical record within 6 months of incident CKD. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for CKD coding. We found that, pre-eGFR reporting, 42.5 % of incident CKD patients were coded for CKD. Female gender, increased age, and non-Black race were associated with lower serum creatinine and lower prevalence of coding but comparable eGFR. Prevalence of coding was not statistically significantly higher overall (49.6 %, P = 0.27) or in subgroups after the institution of automated eGFR reporting. However, gaps in coding by age and gender were narrowed post-eGFR, even after adjustment for sociodemographic and clinical characteristics: 47.9 % of those <65 and 30.3 % of those ≥ 65 were coded pre-eGFR, compared to 49.0 % and 52.0 % post-eGFR (OR = 0.43 and 1.16); similarly, 53.2 % of males and 25.4 % of females were coded pre-eGFR compared to 52.8 % and 44.0 % post-eGFR (OR 0.28 vs. 0.64). Blacks were more likely to be coded in the post-eGFR period: OR = 1.08 and 1.43 (P (interaction) > 0.05). Automated eGFR reporting may help improve CKD recognition, but it is not sufficient to resolve under identification of CKD by safety net providers.
Authors:
Laura C Plantinga; Delphine S Tuot; Vanessa Grubbs; Chi-yuan Hsu; Neil R Powe
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of urban health : bulletin of the New York Academy of Medicine     Volume:  89     ISSN:  1468-2869     ISO Abbreviation:  J Urban Health     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-28     Completed Date:  2013-06-25     Revised Date:  2014-04-29    
Medline Journal Info:
Nlm Unique ID:  9809909     Medline TA:  J Urban Health     Country:  United States    
Other Details:
Languages:  eng     Pagination:  965-76     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Clinical Coding / standards*,  statistics & numerical data
Cohort Studies
Creatinine / blood
Female
Glomerular Filtration Rate / physiology*
Humans
Incidence
Logistic Models
Male
Medical Records Systems, Computerized / standards*,  statistics & numerical data
Middle Aged
Prevalence
Renal Insufficiency, Chronic / blood,  diagnosis*,  epidemiology,  physiopathology
Retrospective Studies
Risk Assessment
San Francisco / epidemiology
Sex Factors
Urban Population / statistics & numerical data*
Grant Support
ID/Acronym/Agency:
K23 DK094850/DK/NIDDK NIH HHS; K24 DK092291/DK/NIDDK NIH HHS; K24DK02643/DK/NIDDK NIH HHS; K24DK92291/DK/NIDDK NIH HHS; KL2 RR024130/RR/NCRR NIH HHS; R01 DK70939/DK/NIDDK NIH HHS; R34DK093992/DK/NIDDK NIH HHS; T32 DK007219/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
AYI8EX34EU/Creatinine
Comments/Corrections

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