Development and Validation of an Electronic Health Record–Based Chronic Kidney Disease Registry

Abstract

SummaryBackground and objectives Chronic kidney disease (CKD) is increasing, and outcomes-related research from diverse health care settings is needed to target appropriate efforts and interventions. We developed an electronic health record (EHR)-based CKD registry at the Cleveland Clinic and validated comorbid conditions. Design, setting, participants, & measurements Patients who had at least one face-to-face outpatient encounter with a Cleveland Clinic health care provider and (1) had two estimated GFR values Ͻ60 ml/min per 1.73 m 2 Ͼ90 days apart as of January 1, 2005 and/or (2) were patients with International Classification of Diseases-9 (ICD-9) diagnosis codes for kidney disease were included.Results Our registry includes 57,276 patients (53,399 patients met estimated GFR criteria and 3877 patients met ICD-9 diagnosis code criteria) as of March 2010. Mean age was 69.5 Ϯ 13.4 years, with 55% women and 12% African Americans. Medicare is the primary insurer for more than one half of the study cohort. The statistics to assess the extent of agreement between the administrative dataset extracted from the EHR and actual EHR chart review showed substantial agreement (Ͼ0.80) for all conditions except for coronary artery disease and hypertension, which had moderate agreement (Ͻ0.60).Conclusions Development of an EHR-based CKD registry is feasible in a large health system, and the comorbid conditions included in the registry are reliable. In addition to conducting research studies, such a registry could help to improve the quality of care delivered to CKD patients and complement the ongoing nationwide efforts to develop a CKD surveillance project.

Metabolic Syndrome, ESRD, and Death in CKD

“…The development and validation of this registry at Cleveland Clinic have been described in detail previously (16).…”

“…Demographic variables, such as age, sex, and race/ethnicity, were extracted from the Electronic Health Records. Comorbid conditions were defined using prespecified criteria and previously validated (16). Serum triglycerides and HDL cholesterol were measured using an enzymatic colorimetric test run on the Roche Modular platform for all the study participants at different sites in our health care system.…”

Type 2 Translational Research for CKD

“…For example, electronic health records with automated estimated GFR reporting can help primary care providers identify patients with CKD and ensure timely referral to nephrologists, while point-of-care decision support may increase adherence to evidence-based guidelines for clinical practice (18,19). Electronic registries identify cohorts and allow for population-level management of patients, thereby enhancing the application of guidelines through patient outreach (20). Registries also provide data for local, regional, and national surveillance of trends among patients with CKD.…”

Electronic Health Records Facilitate Development of Disease Registries and More

“…Navaneethan et al (14) describe the construction of a registry for patients with chronic kidney disease (CKD) derived from EHR data. The benefits of welldesigned patient registries are obvious, from allowing better aggregation of patient data for practice assessment or quality improvement to the facilitation of clinical research (15).…”

“…Navaneethan et al (14) from Cleveland Clinic demonstrate how a registry such as one for CKD can be built in an automated manner from EHR data. Their study shows that the quality of data in the registry is comparable to that of the data that would come from a much more labor-intensive and expensive process of human abstraction.…”