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

Marie D. Philipneri, Lisa A. Rocca Rey, Mark A. Schnitzler, Kevin C. Abbott, Daniel C. Brennan, Steven K. Takemoto, Paula M. Buchanan, Thomas E. Burroughs, Lisa M. Willoughby, Krista L. Lentine

Research output: Contribution to journalArticle

43 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)41-52
Number of pages12
JournalClinical and Experimental Nephrology
Volume12
Issue number1
DOIs
Publication statusPublished - Feb 2008

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Insurance Claim Review
Chronic Renal Insufficiency
Nephrology
Angiotensin Receptor Antagonists
Kidney Diseases
Parathyroid Hormone
Angiotensin-Converting Enzyme Inhibitors
Phosphorus
Referral and Consultation
Guideline Adherence
Electronic Health Records
Practice Management
Quality Improvement
Insurance
Practice Guidelines
Prescriptions
Publications
Comorbidity
Demography
Guidelines

Keywords

  • Angiotensin-converting enzyme inhibitors
  • Chronic kidney disease
  • Guideline adherence
  • Laboratory diagnoses
  • Physician's practice patterns
  • Referral and consultation

ASJC Scopus subject areas

  • Nephrology

Cite this

Delivery patterns of recommended chronic kidney disease care in clinical practice : Administrative claims-based analysis and systematic literature review. / Philipneri, Marie D.; Rocca Rey, Lisa A.; Schnitzler, Mark A.; Abbott, Kevin C.; Brennan, Daniel C.; Takemoto, Steven K.; Buchanan, Paula M.; Burroughs, Thomas E.; Willoughby, Lisa M.; Lentine, Krista L.

In: Clinical and Experimental Nephrology, Vol. 12, No. 1, 02.2008, p. 41-52.

Research output: Contribution to journalArticle

Philipneri, MD, Rocca Rey, LA, Schnitzler, MA, Abbott, KC, Brennan, DC, Takemoto, SK, Buchanan, PM, Burroughs, TE, Willoughby, LM & Lentine, KL 2008, 'Delivery patterns of recommended chronic kidney disease care in clinical practice: Administrative claims-based analysis and systematic literature review', Clinical and Experimental Nephrology, vol. 12, no. 1, pp. 41-52. https://doi.org/10.1007/s10157-007-0016-3
Philipneri, Marie D. ; Rocca Rey, Lisa A. ; Schnitzler, Mark A. ; Abbott, Kevin C. ; Brennan, Daniel C. ; Takemoto, Steven K. ; Buchanan, Paula M. ; Burroughs, Thomas E. ; Willoughby, Lisa M. ; Lentine, Krista L. / Delivery patterns of recommended chronic kidney disease care in clinical practice : Administrative claims-based analysis and systematic literature review. In: Clinical and Experimental Nephrology. 2008 ; Vol. 12, No. 1. pp. 41-52.
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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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AU - Abbott, Kevin C.

AU - Brennan, Daniel C.

AU - Takemoto, Steven K.

AU - Buchanan, Paula M.

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