PS3-34: Does Reporting of Estimated Glomerular Filtration Rates Affect Clinician Behavior?

Background/Aims The National Kidney Disease Education Project and other groups have recommended automated calculation and reporting of estimated glomerular filtration (eGFR) rates among all patients who have a serum creatinine measured. Few studies have assessed whether clinical practice patterns have changed in response to this new initiative. We conducted a time series analysis assessing the rate of nephrology referrals, visits and follow up laboratory testing before and after automated reporting was implemented. Methods We conducted a retrospective cohort study of patients who had incident eGFR levels <60 measured before and after implementation of eGFR reporting at Kaiser Permanente Northwest (KPNW). We compared rates of subsequent evidence of clinical recognition including nephrology referral, repeat serum creatinine and proteinuria testing before and after implementation of eGFR reporting. Logistic models were used to compare change in clinical recognition rates controlling for baseline trends, and determine if the change in rates is related to clinician characteristics. Results We found 21,612 patients who had an eGFR <60, had been members for 2 years, were 18 years or older, and did not have a diagnosis of CKD. The number of referrals increased after the eGFR by 1.3 referrals per month (P = .05). However, the trend in monthly referral slowed after eGFR by .59 per month in comparison to the baseline trend (P = .02). Differences in the change in likelihood of referral after eGFR were found for age (P =.01), amount of FTE (P = .04), and type of practice (P = .01). Slope changes in subsequent orders for other testing (i.e., proteinuria) were not significant. Conclusions Following implementation of eGFR reporting, the likelihood of referral to nephrologists increased though the number of nephrology clinic visits did not. Clinicians who were younger, family medicine, and worked full time were more likely to increase referrals after eGFR.

Citation

Micah Thorp, David Smith, Eric Johnson, Nancy Perrin, Jessica Weiss, Suma Vupputuri, Amanda Petrik, Xiuhai Yang. PS3-34: Does Reporting of Estimated Glomerular Filtration Rates Affect Clinician Behavior? Clinical medicine & research. 2013 Sep;11(3):140-141

PMID: 24085913

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