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Original Report: Patient-Oriented, Translational Research

Free Access

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Jolly 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

Author affiliations

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

Corresponding Author

Stacey E. Jolly, MD, MAS

Department of General Internal Medicine

Cleveland Clinic Medicine Institute, Cleveland Clinic

9500 Euclid Avenue, G10, Cleveland, OH 44195 (USA)

E-Mail jollys@ccf.org

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Am J Nephrol 2014;39:288-296

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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


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Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: July 15, 2013
Accepted: January 31, 2014
Published online: April 01, 2014
Issue release date: May 2014

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 5

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

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