退伍军人医疗保健系统临床数据库中高级慢性病的电子表现:模型开发和评估的基于系统的战略
Gajapathiraju Chamarthi1, Tatiana Orozco2, Popy Shell2
1Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL, United States.
Interactive journal of medical research
|July 24, 2023
概括
在电子健康记录中识别晚期慢性病 (CKD) 是一个挑战. 使用估计的淋巴细胞过率 (eGFR) 的新分层电子健康记录 (EHR) 现型,可以改善患有晚期CKD的退伍军人的实时识别.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 医疗信息学 医疗信息学
- 临床研究 临床研究
背景情况:
- 在临床数据库中精确识别晚期 (4-5期) 慢性病 (CKD) 往往是不可靠的.
- 针对这种患者群体是专业临床护理和研究计划的关键.
- 在电子健康记录 (EHR) 中识别晚期CKD的现有方法存在局限性.
研究的目的:
- 开发和验证一个基于系统的战略,用于识别患有晚期CKD的退伍军人.
- 检查常规诊断代码的准确性和预计的基于乳腺透率 (eGFR) 的表型,以检查晚期CKD在EHR中.
- 在退伍军人医疗保健系统中创建一个务实的EHR表型,用于实时识别先进的CKD队列.
主要方法:
- 在12个月内提取了一组患有晚期CKD的退伍军人,使用最新eGFR≤30ml·min-1·1.73m-2或ICD-10代码 (N18.4,N18.5) 的组合.
- 使用先前的EHR表型 (诊断代码,单个eGFR<30) 和已开发的操作表型 (高,中,低风险) 估计的晚期CKD患病率.
- 在6个月的随访期间,通过评估持续EGFR<30ml·min−1·1.73m−2的可能性来评估表型准确性.
主要成果:
- 鉴定了1759名退伍军人患有晚期非透析CKD;根据EHR表型,患病率从1%到1.5%不等.
- 诊断代码确定了62.9%,而EGFR指数<30确定了79.1%;高,中,低风险组分别包括52.7%,27.2%和17.9%.
- 新的表型显示了高准确性:94.2%的高风险,71%的中等风险和16.1%的低风险组在6个月的随访中保持了先进的CKD状态.
结论:
- 虽然CKD患病率在EHR表型中显示较小的变化,但在分层的eGFR值时,准确性会提高.
- 开发了一个基于EHR的实用模型,用于实时识别退伍军人中高级CKD.
- 这种分层方法有效地准了患有进展至末期脏疾病风险的患者群体.
相关概念视频
01:25Chronic Kidney Disease I: Introduction
37
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage kidney disease (ESKD). At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate...
37
01:24Chronic Kidney Disease II: Clinical Manifestations
32
Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
32
01:28Chronic Kidney Disease III: Interprofessional Care
42
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
42
01:18Chronic Kidney Disease IV: Nursing Management
25
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
25
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
35
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
35
01:29Acute Kidney Injury III: Clinical Manifestations
34
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
34