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Delivery patterns of recommended chronic kidney disease care in clinical practice: administrative claims-based analysis and systematic literature review

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Abstract

Background

Clinical practice guidelines for management of chronic kidney disease (CKD) have been developed within the Kidney Disease Outcomes Quality Initiative (K/DOQI). Adherence patterns may identify focus areas for quality improvement.

Methods

We retrospectively studied contemporary CKD care patterns within a private health system in the United States, and systematically reviewed literature of reported practices internationally. Five hundred and nineteen patients with moderate CKD (estimated GFR 30–59 ml/min) using healthcare benefits in 2002–2005 were identified from administrative insurance records. Thirty-three relevant publications in 2000–2006 describing care in 77,588 CKD patients were reviewed. Baseline demographic traits and provider specialty were considered as correlates of delivered care. Testing consistent with K/DOQI guidelines and prevalence of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) medication prescriptions were ascertained from billing claims. Care descriptions in the literature sample were based on medical charts, electronic records and/or claims.

Results

KDOQI-consistent measurements of parathyroid hormone (7.1 vs. 0.6%, P = 0.0002), phosphorus (38.2 vs. 1.9%, P < 0.0001) and quantified urinary protein (23.8 vs. 9.4%, P = 0.008) were more common among CKD patients with versus without nephrology referral in the administrative data. Nephrology referral correlated with increased likelihood of testing for parathyroid hormone and phosphorus after adjustment for baseline patient factors. Use of ACEi/ARB medications was more common among patients with nephrology contact (50.0 vs. 30.0%; P = 0.008) but appeared largely driven by higher comorbidity burden. The literature review demonstrated similar practice patterns.

Conclusions

Delivery of CKD care may be monitored by administrative data. There is opportunity for improvement in CKD guideline adherence in practice.

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Acknowledgments

Ms. Buchanan received support from a Public Policy Fellowship from the American Society of Transplantation. Dr. Brennan received support from a grant from the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK), K24-DK002886. Dr. Lentine received support from a grant from the NIDDK, K08-DK073036. An abstract describing a portion of this work was presented at the American Society of Nephrology 39th Annual Renal Week Meeting on November 18, 2006, in San Diego, CA, USA.

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Correspondence to Krista L. Lentine.

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Funding Sources: Ms. Buchanan received support from a Public Policy Fellowship from the American Society of Transplantation. Dr. Brennan received support from a grant from the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK), K24-DK002886. Dr. Lentine received support from a grant from the NIDDK, K08-DK073036.

Appendices

Appendix 1

Table 4

Table 4 Common procedural terminology (CPT) codes used to identify recommended testing of parameters of bone and mineral metabolism, serum lipids and quantified urinary protein according to K/DOQI guidelines

Appendix 2

Table 5

Table 5 List of medical subject heading (MeSH) terms used to perform a systematic review of the literature published from 2000 to 2006 about the delivery of care relating to proteinuria quantification, bone and lipid metabolism assessment and ACEi/ARBs prescription in CKD

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Philipneri, M.D., Rocca Rey, L.A., Schnitzler, M.A. et al. Delivery patterns of recommended chronic kidney disease care in clinical practice: administrative claims-based analysis and systematic literature review. Clin Exp Nephrol 12, 41–52 (2008). https://doi.org/10.1007/s10157-007-0016-3

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