The long-term impact of eGFR reporting on referral patterns.

Area of Science:

• Nephrology
• Public Health Policy
• Healthcare Management

Background:

• The prognostic importance of chronic kidney disease (CKD) prompted automated estimated glomerular filtration rate (eGFR) reporting.
• CKD inclusion in the UK's Quality Outcomes Framework (QOF) for General Medical Services (GMS) contract aimed to improve care.

Purpose of the Study:

• To evaluate the long-term effects of automated eGFR reporting and CKD QOF integration on nephrology referral rates.
• To analyze changes in patient demographics and clinical characteristics post-implementation.

Main Methods:

• Retrospective data collection on new patient referrals to a single NHS Health Board.
• Analysis of referral numbers and patient characteristics from April 2005 to March 2011.

Main Results:

• A significant and sustained increase in nephrology referrals was observed following the introduction of eGFR reporting and CKD QOF domains.
• Referrals showed a sustained increase in the mean age of patients, particularly females, and an increased proportion of female referrals.
• Short-term effects included a transient decrease in average eGFR at referral and shifts in referral patterns for elderly patients with varying CKD severity.

Conclusions:

• The implemented initiatives resulted in a substantial and sustained rise in patient referrals to nephrology services.
• Initial referral changes involved more elderly patients with mild renal impairment and fewer with stage 5 CKD.
• Longer-term trends indicated an increasing referral of an older female patient population with chronic kidney disease.