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

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. Clinical journal of the American Society of Nephrology : CJASN. 2014 Jan 1; 9(1):29-36.

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Abstract:

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, and 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.