Duke University
Grant: $50,000 - National Institutes of Health - Sep. 18, 2009
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Award Description: Project Summary: Impact of Automated Reporting of Kidney Function in the Veterans Affairs Healthcare System Chronic kidney disease (CKD) is a readily treatable but under-recognized condition that is common in the general population. Although easily detected and treatable, CKD remains under-recognized and poorly managed. As a result, various expert panels recommended that laboratories automatically report kidney function with the estimated glomerular filtration rate (eGFR) result in addition to serum creatinine (traditional biomarker used to assess kidney function). Accordingly, to improve recognition of patients with CKD, many laboratories now report kidney function using this new method, but the impact on rates of detection and treatment are not clear. Using large databases from a national, vertically-integrated health system that implemented eGFR reporting beginning in 2003 (Veterans Affairs [VA] Healthcare System), we will determine whether eGFR reporting improved the treatment of patients with CKD from 2002 to 2009. By examining rates of outcomes before and after the eGFR reporting, this study will evaluate whether there were improvements in treatment with appropriate medications, specifically angiotensin antagonists such as ACE inhibitors or angiotensin receptor blockers (primary aim). The impact of eGFR reporting at the facility level will be assessed by determining changes over time of repeated cross-sectional samples of patients at each VA facility using longitudinal data analytic techniques. After setting the timing of eGFR activation at each site, the study sample will be identified beginning in 2000 by including a random sample of all veterans with kidney disease from every VA facility with an acute care hospital. Following data cleaning and validation of merged VA datasets through 2009, the impact of eGFR activation will be determined with before and after comparisons of medication prescribing. If the response was insufficient, additional interventions to improve CKD care will be necessary to stem the consequences of rising incidence and prevalence. If the response was sufficient, understanding which patients were identified and treated over others will inform subsequent quality improvement efforts. Relevance: In addition, these results may have implications for future roll-outs of other analogous and forthcoming laboratory reporting innovations that provide greater information on the presence or severity of disease. Although the MDRD-based eGFR represents a significant improvement over creatinine alone, newer equations and biomarker combinations that aim to decrease its bias are being evaluated for use.
Project Description: See Award Description
Jobs Summary: NA (Total jobs reported: 0)
Project Status: Less Than 50% Completed
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