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Chronic kidney disease in an electronic health record problem list: quality of care, ESRD, and mortality
Stacey E Jolly1, Sankar D Navaneethan, Jesse D Schold
1Department of General Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Chronic kidney disease (CKD) recognition in electronic health records was low but improved care processes. However, this recognition did not impact end-stage renal disease (ESRD) or mortality outcomes.
Area of Science:
- Nephrology
- Health Informatics
- Clinical Outcomes Research
Background:
- The impact of chronic kidney disease (CKD) recognition within electronic health record (EHR) problem lists on care processes and end-stage renal disease (ESRD) outcomes remains unclear.
- Investigating the association between EHR-based CKD recognition and subsequent clinical management and patient prognosis is crucial for optimizing kidney disease care.
Purpose of the Study:
- To determine if recognizing chronic kidney disease (CKD) in an electronic health record (EHR) problem list influences care processes and clinical outcomes, specifically end-stage renal disease (ESRD) and mortality.
- To assess the rate of CKD recognition in EHRs and its correlation with the ordering of CKD-specific laboratory tests.
Main Methods:
- A retrospective analysis of 25,742 patients in an EHR-based CKD registry from 2005-2009.
- CKD recognition was defined by the presence of relevant ICD-9 codes on the problem list. Propensity score matching was used to compare patients with and without CKD recognition.
- Differences in demographics, clinical factors, ESRD development, mortality, and the utilization of CKD-specific laboratory tests (e.g., intact parathyroid hormone, vitamin D, phosphorus, proteinuria) were examined before and after recognition.
Main Results:
- Only 11% of patients had CKD recognition in their EHR problem list, with recognized patients being younger, more often male, and African-American.
- Patients with CKD recognition were significantly more likely to have CKD-specific laboratory tests performed, particularly those with estimated glomerular filtration rate (eGFR) 30-59 and eGFR <30.
- Despite improved care processes, CKD recognition in the EHR problem list was not independently associated with a reduced risk of ESRD or mortality.
Conclusions:
- CKD recognition within EHR problem lists is infrequent but effectively increases the performance of CKD-specific care processes.
- While care processes are enhanced, the current study found no significant impact of EHR-based CKD recognition on the development of ESRD or patient mortality.
- Further research may be needed to explore interventions that can translate improved care processes into better long-term clinical outcomes for CKD patients.
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.
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