What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic kidney disease (n=20388). Intervention: Quality of care for chronic kidney disease. Primary outcome: Quality of care indicators (nephrology visits, medication use, laboratory testing, preparation for dialysis).

What does this research mean for the field?

Significant deficiencies persist in real-world chronic kidney disease care, characterized by delayed nephrology referrals, suboptimal medication management, and frequent unplanned inpatient starts of dialysis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 1, 2015BMC NephrologyOpen Access

An observational study of the quality of care for chronic kidney disease: a Buffalo and Albany, New York metropolitan area study

Q: What are the key findings of this study?

Analysis of 20,388 insured patients with chronic kidney disease revealed significant care deficiencies, including only 55.6% of stage 4 patients seeing a nephrologist within one year and 52% of those developing end-stage renal disease starting dialysis as inpatients.

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Key result

Insured CKD patients face major care gaps, with ~52% starting dialysis as inpatients upon developing ESRD.

n=20,388

Why the study?

Apparent deficiencies in the quality of care for chronic kidney disease patients, including medication use and nephrology referral, were not well characterized regionally.

Population

20,388 insured patients with CKD stage 3a and above in Buffalo and Albany, New York metropolitan areas

Design

Retrospective cross-sectional study using insurance claims, laboratory, and prescription data

Authors

PAPradeep AroraBuffalo VA Medical Center PEPeter L. ElkinBuffalo State University JEJoseph EberleBuffalo Medical Group

Discussion

Member takes

Implication

Persistent CKD care gaps warrant quality improvement efforts; leaves open whether interventions enhance referral and dialysis planning.

Study Design

Type

Cross-Sectional (n=20,388)

Structured PICO

Population

20,388 insured patients with chronic kidney disease (eGFR < 60 ml/min/1.73 m2) in the Buffalo and Albany metropolitan areas, evaluated for quality of care metrics.

Outcome

Quality of care indices including frequency of physician visits, specialty referral, laboratory testing, and medication use

This regional observational study highlights significant deficiencies in CKD care, including delayed nephrology referral, underuse of RAS blockers, inappropriate NSAID use, and lack of preparation for dialysis.

Limitations

Unable to obtain data on patients' race from the provider
Excluded patients with CKD stages 1 and 2
Claims data does not include information on uninsured patients
Claims data do not generally include over-the-counter medications, likely underestimating NSAID use
Reasons for urgent inpatient dialysis and delayed or missing claims for nephrology could not be established
Unable to obtain data on patients' race
Requisite laboratory data was available for only about 15% of insured individuals
Claims data do not generally include over-the-counter medications

Cite This Study

Arora et al. (2015) conducted a cross-sectional in Chronic kidney disease (n=20,388). Quality of care for chronic kidney disease was evaluated on Quality of care indicators (nephrology visits, medication use, laboratory testing, preparation for dialysis). Analysis of 20,388 insured patients with chronic kidney disease revealed significant care deficiencies, including only 55.6% of stage 4 patients seeing a nephrologist within one year and 52% of those developing end-stage renal disease starting dialysis as inpatients.

synapsesocial.com/papers/6aa87aefb35a280688f33781 https://doi.org/10.1186/s12882-015-0194-2

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December 1, 2015BMC NephrologyOpen Access

An observational study of the quality of care for chronic kidney disease: a Buffalo and Albany, New York metropolitan area study

View Full Paper

Ask AI

Bookmark

Key result

Insured CKD patients face major care gaps, with ~52% starting dialysis as inpatients upon developing ESRD.

n=20,388

Why the study?

Apparent deficiencies in the quality of care for chronic kidney disease patients, including medication use and nephrology referral, were not well characterized regionally.

Population

20,388 insured patients with CKD stage 3a and above in Buffalo and Albany, New York metropolitan areas

Design

Retrospective cross-sectional study using insurance claims, laboratory, and prescription data

Authors

PAPradeep AroraBuffalo VA Medical Center PEPeter L. ElkinBuffalo State University JEJoseph EberleBuffalo Medical Group

Discussion

Member takes

Implication

Persistent CKD care gaps warrant quality improvement efforts; leaves open whether interventions enhance referral and dialysis planning.

Study Design

Type

Cross-Sectional (n=20,388)

Structured PICO

Population

20,388 insured patients with chronic kidney disease (eGFR < 60 ml/min/1.73 m2) in the Buffalo and Albany metropolitan areas, evaluated for quality of care metrics.

Outcome

Quality of care indices including frequency of physician visits, specialty referral, laboratory testing, and medication use

Limitations

Unable to obtain data on patients' race from the provider
Excluded patients with CKD stages 1 and 2
Claims data does not include information on uninsured patients
Claims data do not generally include over-the-counter medications, likely underestimating NSAID use
Reasons for urgent inpatient dialysis and delayed or missing claims for nephrology could not be established
Unable to obtain data on patients' race
Requisite laboratory data was available for only about 15% of insured individuals
Claims data do not generally include over-the-counter medications

Cite This Study

synapsesocial.com/papers/6aa87aefb35a280688f33781 https://doi.org/10.1186/s12882-015-0194-2

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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