Electronic problem list documentation of chronic kidney disease and quality of care

BMC Nephrology

Adam Wright²  David W Bates¹  Jeffrey A Linder²  Lipika Samal² 

[1]Harvard School of Public Health, Boston, MA, USA

[2]Harvard Medical School, Boston, MA, USA

关键词: Electronic medical record;    Primary care;    Chronic kidney disease;    Electronic problem list;    Electronic health record;   

Others  :  1082692
DOI  :  10.1186/1471-2369-15-70

 received in 2013-07-01, accepted in 2014-03-25,  发布年份 2014

【 摘 要 】

Background

Chronic kidney disease (CKD) is increasingly common and under-recognized in primary care clinics, leading to low rates of stage-appropriate monitoring and treatment. Our objective was to determine whether electronic problem list documentation of CKD is associated with monitoring and treatment.

Methods

This is a cross-sectional observational study of patients with stage 3 or 4 CKD, defined as two past estimated glomerular filtration rates (eGFR) 15-60 mL/min/1.73 m² separated by 90 days and collected between 2007-2008. We examined the association of problem list documentation with: 1) serum eGFR monitoring test, 2) urine protein or albumin monitoring test, 3) an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACE/ARB) prescription, 4) mean systolic blood pressure (BP), and 5) BP control.

Results

Out of 3,149 patients with stage 3 or 4 CKD, only 16% of patients had CKD documented on the problem list. After adjustment for eGFR, gender, and race/ethnicity and after clustering by physician, problem list documentation of CKD was associated with serum eGFR testing (97% with problem list documentation vs. 94% without problem list documentation, p = 0.02) and urine protein testing (47% with problem list documentation vs. 40% without problem list documentation, p = 0.04). After adjustment, problem list documentation was not associated with ACE/ARB prescription, mean systolic BP, or BP control.

Conclusions

Documentation of CKD on the electronic problem list is rare. Patients with CKD documentation have better stage-appropriate monitoring of the disease, but do not have higher rates of blood pressure treatment or better blood pressure control. Interventions aimed at increasing documentation of CKD on the problem list may improve stage-appropriate monitoring, but may not improve clinical outcomes.

【 授权许可】

   
2014 Samal et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA 2007, 298(17):2038-2047.
• [2]Giatras I, Lau J, Levey AS: Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta-analysis of randomized trials: angiotensin-converting-enzyme inhibition and progressive renal disease study group. Ann Intern Med 1997, 127(5):337-345.
• [3]Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG, African American Study of Kidney Disease and Hypertension Study Group: Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002, 288(19):2421-2431.
• [4]Ruggenenti P, Fassi A, Ilieva AP, Bruno S, Iliev IP, Brusegan V, Rubis N, Gherardi G, Arnoldi F, Ganeva M, Ene-Iordache B, Gaspari F, Perna A, Bossi A, Trevisan R, Dodesini AR, Remuzzi G: Bergamo nephrologic diabetes complications trial (BENEDICT) investigators: preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004, 351(19):1941-1951.
• [5]Sarafidis PA, Khosla N, Bakris GL: Antihypertensive therapy in the presence of proteinuria. Am J Kidney Dis 2007, 49(1):12-26.
• [6]Kidney Disease Outcomes Quality Initiative (K/DOQI): K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004, 43(5 Suppl 1):S1-S290.
• [7]Levey AS, De Jong PE, Coresh J, Nahas ME, Astor BC, Matsushita K, Gansevoort RT, Kasiske BL, Eckardt KU: The definition, classification and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int 2011, 80(1):17-28.
• [8]Stevens LA, Fares G, Fleming J, Martin D, Murthy K, Qiu J, Stark PC, Uhlig K, Van Lente F, Levey AS: Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: evidence for lack of physician awareness of chronic kidney disease. J Am Soc Nephrol 2005, 16(8):2439-2448.
• [9]Lea JP, McClellan WM, Melcher C, Gladstone E, Hostetter T: CKD risk factors reported by primary care physicians: do guidelines make a difference? Am J Kidney Dis 2006, 47(1):72-77.
• [10]Litvin CB, Nietert PJ, Wessell AM, Jenkins RG, Ornstein SM: Recognition and management of CKD in primary care. Am J Kidney Dis 2011, 57(4):646-647.
• [11]Anandarajah S, Tai T, de Lusignan S, Stevens P, O’Donoghue D, Walker M, Hilton S: The validity of searching routinely collected general practice computer data to identify patients with chronic kidney disease (CKD): a manual review of 500 medical records. Nephrol Dial Transplant 2005, 20(10):2089-2096.
• [12]Chase HS, Radhakrishnan J, Shirazian S, Rao MK, Vawdrey DK: Under-documentation of chronic kidney disease in the electronic health record in outpatients. J Am Med Inform Assoc 2010, 17(5):588-594.
• [13]de Lusignan S, Chan T, Stevens P, O’Donoghue D, Hague N, Dzregah B, Van Vlymen J, Walker M, Hilton S: Identifying patients with chronic kidney disease from general practice computer records. Fam Pract 2005, 22(3):234-241.
• [14]Guessous I, McClellan W, Vupputuri S, Wasse H: Low documentation of chronic kidney disease among high-risk patients in a managed care population: a retrospective cohort study. BMC Nephrol 2009, 10:25. BioMed Central Full Text
• [15]Grams ME, Plantinga LC, Hedgeman E, Saran R, Myers GL, Williams DE, Powe NR, CDC CKD Surveillance Team: Validation of CKD and related conditions in existing data sets: a systematic review. Am J Kidney Dis 2011, 57(1):44-54.
• [16]Simborg DW, Starfield BH, Horn SD, Yourtee SA: Information factors affecting problem follow-up in ambulatory care. Med Care 1976, 14(10):848-856.
• [17]Hartung DM, Hunt J, Siemienczuk J, Miller H, Touchette DR: Clinical implications of an accurate problem list on heart failure treatment. J Gen Intern Med 2005, 20(2):143-147.
• [18]Tang PC, Ralston M, Arrigotti MF, Qureshi L, Graham J: Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures. J Am Med Inform Assoc 2007, 14(1):10-15.
• [19]National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39(2 Suppl 1):S1-S266.
• [20]Sequist TD, Gandhi TK, Karson AS, Fiskio JM, Bugbee D, Sperling M, Cook EF, Orav EJ, Fairchild DG, Bates DW: A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc 2005, 12(4):431-437.
• [21]Wright A, Feblowitz J, Maloney FL, Henkin S, Bates DW: Use of an electronic problem list by primary care providers and specialists. J Gen Intern Med 2012, 27(8):968-973.
• [22]Wright A, Pang J, Feblowitz JC, Maloney FL, Wilcox AR, McLoughlin KS, Ramelson H, Schneider L, Bates DW: Improving completeness of electronic problem lists through clinical decision support: a randomized, controlled trial. J Am Med Inform Assoc 2012, 19(4):555-561.
• [23]Kent DM, Jafar TH, Hayward RA, Tighiouart H, Landa M, de Jong P, de Zeeuw D, Remuzzi G, Kamper AL, Levey AS: Progression risk, urinary protein excretion, and treatment effects of angiotensin-converting enzyme inhibitors in nondiabetic kidney disease. J Am Soc Nephrol 2007, 18(6):1959-1965.
• [24]Jones CA, McQuillan GM, Kusek JW, Eberhardt MS, Herman WH, Coresh J, Salive M, Jones CP, Agodoa LY: Serum creatinine levels in the US population: third national health and nutrition examination survey. Am J Kidney Dis 1998, 32(6):992-999.
• [25]Rodriguez RA, Hernandez GT, O’Hare AM, Glidden DV, Perez-Stable EJ: Creatinine levels among mexican americans, puerto ricans, and cuban americans in the hispanic health and nutrition examination survey. Kidney Int 2004, 66(6):2368-2373.
• [26]Gansevoort RT, de Jong PE: The case for using albuminuria in staging chronic kidney disease. J Am Soc Nephrol 2009, 20(3):465-468.
• [27]Gansevoort RT, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, Jong PE, Coresh J, Gansevoort RT, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, El-Nahas M, Eckardt KU, Kasiske BL, Ninomiya T, Chalmers J, Macmahon S, Tonelli M, Hemmelgarn B, Wang Y, Atkins RC, Polkinghorne KR, Chadban SJ, Shankar A, The Chronic Kidney Disease Prognosis Consortium, et al.: Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes in both general and high-risk populations: a collaborative meta-analysis of general and high-risk population cohorts. Kidney Int 2011, 80(1):93-104.
• [28]Parchman ML, Pugh JA, Romero RL, Bowers KW: Competing demands or clinical inertia: the case of elevated glycosylated hemoglobin. Ann Fam Med 2007, 5(3):196-201.
• [29]Allen AS, Forman JP, Orav EJ, Bates DW, Denker BM, Sequist TD: Primary care management of chronic kidney disease. J Gen Intern Med 2011, 26(4):386-392.
• [30]Abdel-Kader K, Fischer GS, Li J, Moore CG, Hess R, Unruh ML: Automated clinical reminders for primary care providers in the care of CKD: a small cluster-randomized controlled trial. Am J Kidney Dis 2011, 58(6):894-902.
• [31]Powers BJ, Olsen MK, Smith VA, Woolson RF, Bosworth HB, Oddone EZ: Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med 2011, 154(12):781.