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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 Portfolio Assignment: Equity |
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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. External Links for this ProjectDimensions for VA Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects. Learn more about Dimensions for VA. VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project PUBLICATIONS:Journal Articles
DRA:
Health Systems Science, Kidney Disorders
DRE: Treatment - Observational Keywords: Clinical practice guidelines, Cost, Minority MeSH Terms: none |
