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IAA 06-214 – HSR&D Study

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IAA 06-214
Treatment Cost for Veterans with Chronic Kidney Disease
Guoqing John Chen PhD MD MPH
Michael E. DeBakey VA Medical Center, Houston, TX
Houston, TX
Funding Period: March 2008 - December 2010

BACKGROUND/RATIONALE:
Chronic kidney disease (CKD) is a growing public health concern. CKD is a highly prevalent condition affecting more than 20 million Americans including veterans. The condition is associated with poor patient outcomes and increased health care costs. In spite of significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that racial and ethnic minorities tend to receive suboptimal care compared to non-minorities and that patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than non-minorities. However, little is known about racial/ethnic disparities in CKD care and the impact of provision of guideline concordant CKD care on treatment cost among veterans with incident, early stage CKD within the VA healthcare system.

OBJECTIVE(S):
The overall goal of this study was to determine racial/ethnic variations in receipt of guideline concordant care and examine the effect of guideline concordant care for CKD on treatment cost. The specific aims of the proposed project were as follows:
Specific Aim 1: To determine racial/ethnic disparities in receipt of optimal care for incident CKD patients in early stage within 12 months from the date of initial CKD diagnosis as defined by the K/DOQI (National Kidney Disease Outcome Quality Initiative).
Specific Aim 2: To examine impact of provision of guideline concordant CKD care for incident CKD patients in early stage within 12 months from the date of initial CKD diagnosis on treatment cost from the VA healthcare system perspective.

METHODS:
To address these specific aims, we conducted a retrospective cohort analysis with two phases. In the first phase (baseline), we identified incident CKD patients with stage 3 from the VA DSS lab database. The characteristics of these incident cases and treatment patterns within the first 12 months after the initial CKD diagnosis were examined. In the second phase (follow-up), the patients were followed from their first CKD diagnosis date to death, censored or September 30, 2005. Descriptive and multivariate regression methods were used in the analysis.

FINDINGS/RESULTS:
Using FY2000-02 DSS Lab database on serum creatinine tests, we identified 143,334 veterans who met CKD stage 3 diagnosis criteria and the inclusion and exclusion criteria of the study. Our main findings are: 1) There were large variations in receipt of guideline concordant CKD care across all racial/ethnic groups; 2) Usage of ACEIs/ARBs (angiotensin convertin enzype inhibitors and angiotensin receptor inhibitors) was suboptimal in CKD patients with either diabetes or hypertension; 3) There is a lack of access to nephrologist and dietician care; 4) Provision of lipid testing may reduce treatment cost per person per month.

IMPACT:
The findings from this study provide useful information to design interventional strategies targeting clinically modifiable factors that are most likely to influence the quality of CKD care and potential reduce any detected racial/ethnic disparities in provision of CKD care.

PUBLICATIONS:

Journal Articles

  1. Chen G, Egede LE, Moran WP. Adherence to Guideline-Recommended Care for Veterans with Chronic Kidney Disease in VA. Journal of general internal medicine. 2010 Jan 1; 25(Suppl 3):S219.
Conference Presentations

  1. Chen GJ, Yu HJ, Jia H, Egede LE, Huchston FN. Racial disparities in quality of care for Veterans with chronic kidney disease variations in rural areas. Poster session presented at: VA HSR&D Field-Based Equity Conference; 2010 Sep 12; Boston, MA.
  2. Marshall CL, Chen GJ, Robinson CN, Balentine CJ, Berger DH, Albo D. Laparoscopic surgery decreases the cost of Veterans with colon cancer. Poster session presented at: Association of Veteran Affairs Surgeons Annual Meeting; 2010 May 9; Indianapolis, IN.
  3. Jia H, Cowper D, Chen GJ, Vogel WB, Tang Y, Wilson L. Rural and urban stroke patients: Who is counting what? Paper presented at: VA HSR&D Rural Health / VA Office of Rural Health Field-Based Meeting; 2010 May 6; Portland, ME.
  4. Chen GJ. Variations in quality of care for Veterans with chronic kidney disease in rural areas. Poster session presented at: VA HSR&D Rural Health / VA Office of Rural Health Field-Based Meeting; 2010 May 5; Portland, ME.
  5. Chen GJ, Moran WP, Yu HJ, Jia H, Egede LE. Adherence to guideline-recommended care for Veterans with chronic kidney disease in VA. Paper presented at: Society of General Internal Medicine Annual Meeting; 2010 Apr 28; Minneapolis, MN.
  6. Chen GJ, Yu HJ, Jia H, Egede LE. Underutilizing nephrologists' care for Veterans with chronic kidney disease in VA. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2010 Apr 28; Minneapolis, MN.
  7. Chen GJ, Yu HJ, Jia H. Burden of depression and utilization among Veterans with chronic kidney disease. Poster session presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 27; Little Rock, AR.


DRA: Kidney Disorders, Health Systems
DRE: Treatment - Observational
Keywords: Clinical practice guidelines, Cost, Disparities, Ethnicity/Race, Minority, Quality of Care
MeSH Terms: none

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