Nephrology Care in a Fully Integrated Care Model

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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“…31, 32 But, there is evidence that a chronic care or integrated patient centered approach will work. 33, 34 …”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Jolly¹,

Navaneethan

Schold

et al. 2014

Am J Nephrol

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“…En respuesta a la complejidad del manejo que requieren estos pacientes, se han propuesto modelos de gestión de enfermedad como una estrategia integral y costo-eficiente para alcanzar mejores resultados en salud [13][14][15][16] ; adicionalmente, en poblaciones geográficamente dispersas y que reciben servicios no siempre integrados en sus diferentes niveles de atención, los modelos de gestión de enfermedad se podrían complementar con la filosofía de las Redes Integradas de Sistemas de Salud, lanzada por la Organización Panamericana de la Salud (OPS) 17 y la gestoría de casos, estrategias que ya han demostrado su eficacia [18][19][20] . En los modernos sistemas de salud, la innovación en modelos que entreguen cuidado médico de manera más integral, más eficiente y con desenlaces de excelencia para el paciente y la sociedad, son una ruta hacia el mejoramiento de las condiciones de vida de las poblaciones.…”

Section: Hsource)unclassified