Journal Article

Development of an electronic health record-based chronic kidney disease registry to promote population health management

Maron, Jason K., Mendu, Mallika L., Weilburg, Jeffrey B., Sequist, Thomas D., Mount, David B., Rao, Sandhya K., Mutter, Walter P., Chaguturu, Sreekanth K., Burdge, Kelly A., Waikar, Sushrut S., Ahmed, Salman, Steele, David J. R., May, Megan F.

2019

Overview

Background Electronic health record (EHR) based chronic kidney disease (CKD) registries are central to population health strategies to improve CKD care. In 2015, Partners Healthcare System (PHS), encompassing multiple academic and community hospitals and outpatient care facilities in Massachusetts, developed an EHR-based CKD registry to identify opportunities for quality improvement, defined as improvement on both process measures and outcomes measures associated with clinical care. Methods Patients are included in the registry based on the following criteria: 1) two estimated glomerular filtration rate (eGFR) results < 60 ml/min/1.73m 2 separated by 90 days, including the most recent eGFR being < 60 ml/min/1.73m 2 ; or 2) the most recent two urine protein values > 300 mg protein/g creatinine on either urine total protein/creatinine ratio or urine albumin/creatinine ratio; or 3) an EHR problem list diagnosis of end stage renal disease (ESRD). The registry categorizes patients by CKD stage and includes rates of annual testing for eGFR and proteinuria, blood pressure control, use of angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), nephrotoxic medication use, hepatitis B virus (HBV) immunization, vascular access placement, transplant status, CKD progression risk; number of outpatient nephrology visits, and hospitalizations. Results The CKD registry includes 60,503 patients and has revealed several opportunities for care improvement including 1) annual proteinuria testing performed for 17% (stage 3) and 31% (stage 4) of patients; 2) ACE-I/ARB used in 41% (stage 3) and 46% (stage 4) of patients; 3) nephrotoxic medications used among 23% of stage 4 patients; and 4) 89% of stage 4 patients lack HBV immunity. For advanced CKD patients there are opportunities to improve vascular access placement, transplant referrals and outpatient nephrology contact. Conclusions A CKD registry can identify modifiable care gaps across the spectrum of CKD care and enable population health strategy implementation. No linkage to Social Security Death Master File or US Renal Data System (USRDS) databases limits our ability to track mortality and progression to ESRD.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Ambulatory care / Angiotensin / Angiotensin converting enzyme / Angiotensins / Blood pressure / Care and treatment / Chronic illnesses / Chronic kidney disease / Chronic kidney failure / Clinical outcomes / Collaboration / Creatinine / Delivery of Health Care, Integrated - methods / Delivery of Health Care, Integrated - standards / Diagnosis / Electronic health record / Electronic health records / Electronic Health Records - organization & administration / Electronic medical records / Electronic records / Enzyme inhibitors / Enzymes / Epidemiology and Health Outcomes / Epidermal growth factor receptors / Female / Glomerular filtration rate / Health care / Health care reform / Health Services Needs and Demand / Hepatitis / Hepatitis B / Hepatitis B virus / Hospitals / Humans / Identification / Immunization / Internal Medicine / Kidney diseases / Kidney Function Tests - methods / Kidney Function Tests - statistics & numerical data / Laboratories / Male / Management / Massachusetts - epidemiology / Medical records / Medicine / Medicine & Public Health / Methods / Middle Aged / Mortality / Nephrology / Patient Acuity / Patient care / Patient Care Management - methods / Patient Care Management - statistics & numerical data / Patients / Peptidyl-dipeptidase A / Population / Population Health Management / Primary care / Proteins / Proteinuria / Quality / Quality control / Quality Improvement - organization & administration / Registries (Medicine) / Registries - statistics & numerical data / Registry / Renal Insufficiency, Chronic - epidemiology / Renal Insufficiency, Chronic - therapy / Research Article / Transplants & implants / Urine