The long-term impact of eGFR reporting on referral patterns

Phillips, L. A.; Phillips, Bethan; Meran, Soma; Russell, Jennifer St. Clair; Zouwail, Soha; Riley, Stephen; Phillips, Aled Owain

doi:10.1016/j.ejim.2013.08.001

Cited by 10 publications

(14 citation statements)

References 24 publications

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“…Similar to the present findings, Akbari and colleagues found that at an academic centre in Ottawa, Ontario, only 55% of referrals were considered necessary using similar criteria to those used in KidneyWise (eGFR<30 mL/min/1.73 m 2 , ACR>60 mg/mmol, or 20% decline in eGFR over 1 year) 18. Another study found that despite the implementation of an educational intervention prior to eGFR reporting, referral volume increased 19. Conversely, a targeted educational intervention in nine primary care and five nephrology practices demonstrated an increase in the proportion of patients with an eGFR<,30 mL/min/1.73 m 2 who were referred to nephrology 23…”

Section: Discussionsupporting

confidence: 83%

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Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

et al. 2020

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ObjectivesChronic kidney disease (CKD) is common; therefore, coordination of care between primary care and nephrology is important. Ontario Renal Network’s KidneyWise toolkit was developed to provide guidance on the detection and management of people with CKD in primary care (www.kidneywise.ca). The aim of this study was to evaluate the impact of the April 2015 KidneyWise toolkit release on the characteristics of primary care referrals to nephrology.Design and settingThe study was a prospective pre-post design conducted at two nephrology sites (community site: Trillium Health Partners in Mississauga, Ontario, Canada, and academic site: St Joseph’s Healthcare in Hamilton, Ontario, Canada). Referrals were compared during the 3-month time period immediately prior to, and during a 3-month period 1 year after, the toolkit release.Primary and secondary outcome measuresThe primary outcome was the change in proportion of referrals for CKD that met the KidneyWise criteria. Additional secondary referral and quality of care outcomes were also evaluated. Multivariable logistic regression was used to evaluate preselected variables for their independent association with referrals that met the KidneyWise criteria.ResultsThe proportion of referrals for CKD among people who met the KidneyWise referral criteria did not significantly change from pre-KidneyWise to post-KidneyWise implementation (44.7% vs 45.8%, respectively, adjusted OR 1.16, 95% CI 0.85 to 1.59, p=0.36). The proportion of referrals for CKD that provided a urine albumin-creatinine ratio significantly increased post-KidneyWise (25.8% vs 43.8%, adjusted OR 1.45, 95% CI 1.06 to 1.97, p=0.02). The significant independent predictors of meeting the KidneyWise referral criteria were academic site, increased age and use of the KidneyWise referral form.ConclusionsWe did not observe any change in the proportion of appropriate referrals for CKD at two large nephrology centres 1 year after implementation of the KidneyWise toolkit.

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Section: Discussionsupporting

confidence: 83%

“…A number of studies have examined the characteristics of primary care referrals to nephrology, including the appropriateness of referrals 18–22. In many of these studies, the introduction of automated eGFR has led to an increased volume of referrals, many deemed perhaps unnecessary.…”

Section: Discussionmentioning

confidence: 99%

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

et al. 2020

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“…It is possible that physicians still base their decision of referral on serum creatinine rather than on eGFR. Automated reporting of eGFR may facilitate physician awareness and has shown to lead to a sustained increase in referrals [42,43]. From 2016, the Stockholm region will implement automatic eGFR reporting, which may influence CKD recognition and care.…”

Section: O R I G I N a L A R T I C L Ementioning

confidence: 99%

Prevalence and recognition of chronic kidney disease in Stockholm healthcare

Gasparini

Evans

Coresh

et al. 2016

Nephrol. Dial. Transplant.

108

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A B S T R AC TBackground. Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden. Methods. We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m

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“…Introduction of the CKD stage classification scheme by CMS in 2005, whereby some measure of the severity of CKD could be quantified for billing purposes, may have been a factor. Additionally, automated reporting of eGFR on routine laboratory reporting may have contributed (14,15), but this is far from certain (16). If these suppositions are correct, they constitute a powerful public health message about how early referral to the appropriate specialist (the nephrologist) can facilitate a procedure (creation of an AVF) that results in reduced mortality in an ill and vulnerable population (patients on incident dialysis), a hypothesis backed by evidence (17).…”

Section: Discussionmentioning

confidence: 99%

The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go?

Wetmore

Liu

et al. 2016

CJASN

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The Healthy People 2020 initiative established goals for patients with CKD and ESRD. We assessed United States progress toward some of these key goals. Using data from the Centers for Medicare and Medicaid Services ESRD database, we created yearly cohorts of patients on incident and prevalent dialysis from 2000 to 2013. Change in event rate or proportion change over the study years was modeled using Poisson regression with adjustment for age, race, sex, and primary cause of ESRD. For all-cause mortality in prevalent patients, Healthy People 2020 sought approximately 0.8% relative annual improvement; actual improvement was 2.7%. Improvement was greatest for patients ages 18-44 years old (3.8%; P<0.01 versus 2.8% for ages 65-74 years old) and 2.3% even for patients ages ≥75 years old. For mortality in incident patients, the relative annual decrease was 2.1% overall, a twofold improvement over the goal; mortality decreased nearly twice as much in black as in white patients (3.2% versus 1.8%; P<0.001). Geographic variation was substantial; the relative annual decrease was 0.6% in the Midwest and more than fourfold greater (2.7%) in the South. Cardiovascular mortality in prevalent patients decreased dramatically at 5.0% per year, far exceeding the annual goal of approximately 0.8%; the decrease was greatest in patients ages ≥75 years old (5.5%; P<0.001 versus ages 65-74 years old; 5.1%). The relative annual increase in percentages of patients with a fistula at dialysis initiation was 2.4%, roughly three times the goal; the increase was greater for black than white patients (3.2% versus 2.3%; P<0.01). Adjusted regional differences varied greater than twofold: 2.0% for the South versus 4.1% for the Midwest. Thus, although gains have been substantial, not all groups have benefitted equally. Goal development for Healthy People 2030 should consider changes in goal paradigms, such as tailoring by geographic region and incorporating patient-centered goals.

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The long-term impact of eGFR reporting on referral patterns

Cited by 10 publications

References 24 publications

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

Prevalence and recognition of chronic kidney disease in Stockholm healthcare

The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go?

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