Impact of automatic reporting of estimated glomerular filtration on chronic kidney disease detection and patient care in a hospital setting

Amamoo, Monique Ahinee

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March 21, 2019

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Amamoo, Monique Ahinee
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

BACKGROUND AND OBJECTIVES: In an attempt to address rising concerns about low and delayed detection of chronic kidney disease (CKD) several healthcare organizations and clinical laboratories developed initiatives to automatically report estimated glomerular filtration rates (eGFR) in response to the National Kidney Foundation- Kidney Disease Outcome Quality Initiative (KDOQI) clinical recommendations. In April 2005 the University of North Carolina at Chapel Hill Healthcare System (UNCHS), introduced an eGFR reporting initiative to facilitate monitoring of CKD in its patient population. This initiative automatically reports eGFR levels calculated using the Modification of Diet in Renal Disease (MDRD) equation on all serum creatinine tests ordered for adults 18 and older. This doctoral dissertation examined the impact of the UNCHS eGFR reporting initiative on CKD detection and nephrology appointments. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study used administrative billing and electronic medical record data from adult patients who sought care in the University of North Carolina at Chapel Hill Healthcare System from 2004-2010 and had at least one serum creatinine measurement. Patient demographics, CKD diagnosis, comorbidities, and laboratory results were retrieved from medical records. Billing data was used to determine nephrology scheduling status. Measures of CKD detection and nephrology appointments were compared for the 15 months prior, and the 48 months following the introduction of the initiative to automatically report eGFR. RESULTS: An increase of 9% in the overall detection of CKD within the UNC healthcare system was observed following the introduction of the eGFR reporting initiative. Those with moderate CKD, older age, male gender, white race and CKD risk factors had higher detection rates during the period following the introduction of the eGFR reporting initiative, no detectable differences in scheduled nephrology appointments were observed following the UNCHS eGFR reporting initiative. Those with diagnoses of hypertension, diabetes and cardiovascular disease had lower odds of having a nephrology appointment scheduled, irrespective of eGFR reporting period. CONCLUSIONS: Introduction of automated eGFR reporting was followed by a moderate increase in CKD detection. eGFR reporting had no discernible association with scheduling of nephrology appointments within UNCHS.

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