Original Report: Patient-Oriented, Translational Research
Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and MortalityJolly S.E.a · Navaneethan S.D.b · Schold J.D.b, c · Arrigain S.c · Sharp J.W.c · Jain A.K.a, d · Schreiber M.J.b · Simon J.F.b · Nally J.V.b
aDepartment of General Internal Medicine, Medicine Institute, bDepartment of Nephrology and Hypertension, Glickman Urological and Kidney Institute, cDepartment of Quantitative Health Sciences, Cleveland Clinic, and dExplorys, Cleveland, Ohio, USA
Stacey E. Jolly, MD, MAS
Department of General Internal Medicine
Cleveland Clinic Medicine Institute, Cleveland Clinic
9500 Euclid Avenue, G10, Cleveland, OH 44195 (USA)
Do you have an account?
Background: Whether chronic kidney disease (CKD) recognition in an electronic health record (EHR) problem list improves processes of care or clinical outcomes of end-stage renal disease (ESRD) and death is unclear. Methods: We identified patients who had at least 1 year of follow-up (2005-2009) in our EHR-based CKD registry (n = 25,742). CKD recognition was defined by having ICD-9 codes for CKD, diabetic kidney disease, or hypertensive kidney disease in the problem list. We calculated proportions of patients with and without CKD recognition and examined differences by demographics, clinical factors, and development of ESRD or mortality. We evaluated differences in the proportion of patients with CKD-specific laboratory results checked before and after recognition among cases and propensity-matched controls. Results: Only 11% (n = 2,735) had CKD recognition in the problem list and they were younger (68 vs. 71 years), a higher proportion were male (61 vs. 37%) and African-American (21 vs. 10%) compared to those unrecognized. CKD-specific laboratory results for patients with estimated glomerular filtration rate (eGFR) 30-59 including intact parathyroid hormone (23 vs. 6%), vitamin D (22 vs. 18%), phosphorus (29 vs. 7%), and a urine check for proteinuria (55 vs. 36%) were significantly more likely to be done among those with CKD recognition (all p < 0.05). Similar results were found for eGFR <30 except for proteinuria and in our propensity score-matched control analysis. There was no independent association of CKD recognition with ESRD or mortality. Conclusions: CKD recognition in the EHR problem list was low, but translated into more CKD-specific processes of care; however ESRD or mortality were not affected.
© 2014 S. Karger AG, Basel
- Plantinga LC, Tuot DS, Powe NR: Awareness of chronic kidney disease among patients and providers. Adv Chronic Kidney Dis 2010;17:225-236.
- Coresh J, Selvin E, Stevens LA, et al: Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038-2047.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(suppl 1):S1-S266.
- Beddhu S, Nigwekar SU, Ma X, Greene T: Associations of resting heart rate with insulin resistance, cardiovascular events and mortality in chronic kidney disease. Nephrol Dial Transplant 2009;24:2482-2488.
- Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-1305.
- Levey AS, Schoolwerth AC, Burrows NR, Williams DE, Stith KR, McClellan W: Comprehensive public health strategies for preventing the development, progression, and complications of CKD: report of an expert panel convened by the Centers for Disease Control and Prevention. Am J Kidney Dis 2009;53:522-535.
- Levin A: Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial 2003;16:101-105.
- Parikh NI, Hwang SJ, Larson MG, Levy D, Fox CS: Chronic kidney disease as a predictor of cardiovascular disease (from the Framingham Heart Study). Am J Cardiol 2008;102:47-53.
- Levey AS, Atkins R, Coresh J, et al: Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 2007;72:247-259.
Center for Medicare and Medicaid Services. EHR meaningful use overview. A federal government website managed by the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html. Last accessed February 9, 2013.
- Chaudhry B, Wang J, Wu S, et al: Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144:742-752.
- Tang PC, Ralston M, Arrigotti MF, Qureshi L, Graham J: Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures. J Am Med Inform Assoc 2007;14:10-15.
- Cebul RD, Love TE, Jain AK, Hebert CJ: Electronic health records and quality of diabetes care. N Engl J Med 2011;365:825-833.
- Linder JA, Ma J, Bates DW, Middleton B, Stafford RS: Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med 2007;167:1400-1405.
- Holbrook A, Pullenayegum E, Thabane L, et al: Shared electronic vascular risk decision support in primary care: Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness (COMPETE III) randomized trial. Arch Intern Med 2011;171:1736-1744.
- Romano MJ, Stafford RS: Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Arch Intern Med 2011;171:897-903.
- Black AD, Car J, Pagliari C, et al: The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med 2011;8:e1000387.
- Navaneethan SD, Jolly SE, Schold JD, et al: Development and validation of an electronic health record-based chronic kidney disease registry. Clin J Am Soc Nephrol 2010;6:40-49.
Bergstralh EJ, Kosanke JL: Computerized Matching of Cases to Controls. Technical Report Series No. 56. Mayo Clinic, Rochester, Minnesota, 1995; Available at http://mayoresearch.mayo.edu/mayo/research/biostat/upload/56.pdf.
- Guessous I, McClellan W, Vupputuri S, Wasse H: Low documentation of chronic kidney disease among high-risk patients in a managed care population: a retrospective cohort study. BMC Nephrol 2009;10:25.
- Chase HS, Radhakrishnan J, Shirazian S, Rao MK, Vawdrey DK: Under-documentation of chronic kidney disease in the electronic health record in outpatients. J Am Med Inform Assoc 2010;17:588-594.
- Allen AS, Forman JP, Orav EJ, Bates DW, Denker BM, Sequist TD: Primary care management of chronic kidney disease. J Gen Intern Med 2010;26:386-392.
- Plantinga LC, Tuot DS, Grubbs V, Hsu CY, Powe NR: Chronic kidney disease identification in a high-risk urban population: does automated eGFR reporting make a difference? J Urban Health 2012;89:965-976.
- Rao MK, Morris CD, O'Malley JP, Davis MM, Mori M, Anderson S: Documentation and management of CKD in rural primary care. Clin J Am Soc Nephrol 2013;8:739-748.
- Litvin CB, Nietert PJ, Wessell AM, Jenkins RG, Ornstein SM: Recognition and management of CKD in primary care. Am J Kidney Dis 2011;57:646-647.
- Hartung DM, Hunt J, Siemienczuk J, Miller H, Touchette DR: Clinical implications of an accurate problem list on heart failure treatment. J Gen Intern Med 2005;20:143-147.
- Dorr D, Bonner LM, Cohen AN, et al: Informatics systems to promote improved care for chronic illness: a literature review. J Am Med Inform Assoc 2007;14:156-163.
- Navaneethan SD, Jolly SE, Sharp J, et al: Electronic health records: a new tool to combat chronic kidney disease? Clin Nephrol 2013;79:175-183.
- Lee BJ, Forbes K: The role of specialists in managing the health of populations with chronic illness: the example of chronic kidney disease. BMJ 2009;339:b2395.
- Drawz PE, Miller RT, Singh S, Watts B, Kern E: Impact of a chronic kidney disease registry and provider education on guideline adherence - a cluster randomized controlled trial. BMC Med Inform Decis Mak 2012;12:62.
- Fox CH, Voleti V, Khan LS, Murray B, Vassalotti J: A quick guide to evidence-based chronic kidney disease care for the primary care physician. Postgrad Med 2008;120:E01-E06.
- Fox CH, Kahn LS, Vassalotti J: A decade after the KDOQI CKD guidelines: impact on primary care. Am J Kidney Dis 2012;60:707-709.
- Narva AS, Sequist TD: Reducing health disparities in American Indians with chronic kidney disease. Semin Nephrol 2010;30:19-25.
- Norfolk E, Hartle J: Nephrology care in a fully integrated care model: lessons from the Geisinger Health System. Clin J Am Soc Nephrol 2013;8:687-693.
- Wright A, Feblowitz J, Maloney FL, Henkin S, Bates DW: Use of an electronic problem list by primary care providers and specialists. J Gen Intern Med 2012;27:968-973.
- Smith KA, Hayward RA: Performance measurement in chronic kidney disease. J Am Soc Nephrol 2011;22:225-234.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.