Effect of practice guidelines on care of chronic kidney disease in the VHA

描述(申请人提供)：一些报告显示，慢性肾脏疾病(CKD)患者的患病率很高，认识不足，经常护理不善。为了改善这一人群的福祉并将终末期肾病(ESRD)的发病率降至最低，已发布了实践指南，其中最引人注目的是肾脏疾病结果质量倡议(K/DOQI)，并得到肾病界的认可。重要的是要通过跟踪临床表现测量(CPM)来监测此类指南的影响，在发布这些备受推崇的指南之前、期间和之后。然而，在慢性肾脏病中，努力做到这一点是困难的，因为向患有这种疾病的人口提供服务的卫生保健系统的结构和边界界定不明确。VHA是美国最大的医疗保健网络，拥有定义明确的组织、可识别的提供者队伍和全面的数据库，非常适合检查实践指南对CKD护理的影响。研究目标：我们将评估包括K/DOQI在内的关键实践指南对CKD患者的识别和护理的影响，方法是连续检查CPM，包括这些指南发布的时间。研究设计：我们将对CKD患者的年度样本进行横断面分析，检查CKD特有的CPM的趋势。研究对象：VHA的受益者将被纳入2000年至2005年的一系列年度队列中的一个，如果他们有实验室证据表明在纳入年份内肾小球滤过率(GFR)=60ml/min定义的肾功能下降。还将探讨CKD的其他定义。研究措施：受试者将从肾功能指数指标监测离散CPM的发生情况，为期12个月。这些绩效指标包括K/DOQI认可的几个指标，以及由于潜在的特定疾病医疗风险或对患者安全的威胁而应避免的其他新措施。CPM将被视为二项变量，在系列样本中以比例表示，并分析拟议研究年份的趋势。预期结果：在像VHA这样的大型卫生保健组织中传播实践指南将导致对CKD患者的识别和护理方面的显著改善，在指定的研究间隔内，拟议的CPM具有显著的有利趋势。这是对VHA管理和临床数据的二次分析，这些数据是几年来被确认患有慢性肾脏疾病的退伍军人，以评估实践指南对他们针对疾病的护理质量的影响。

DESCRIPTION (provided by applicant): Several reports have revealed a high prevalence, under-recognition and frequent poor care of persons with chronic kidney disease (CKD). In an effort to improve the well being of this population and minimize the incidence of end-stage renal disease (ESRD), practice guidelines, including most notably the Kidney Disease Outcome Quality Initiative (K/DOQI), have been released and endorsed by the renal community. It is important to monitor the impact of such guidelines by tracking clinical performance measures (CPM's) before, during and after the release of such highly regarded guidelines. However, efforts to do so are difficult in CKD because of the poorly defined structure and boundaries of the health care systems providing services to the population with this illness. The VHA is the largest health care network in this country with a well-defined organization, identifiable cadre of providers, and a comprehensive data base well suited for the examination of the impact of practice guidelines on CKD care. Study objectives: We will assess the impact of key practice guidelines including K/DOQI on the recognition and care of persons with CKD through examination of CPM's serially over an era that encompasses the time of issuance of these guidelines. Study design: We will conduct cross-sectional analyses of annual samples of persons with CKD examining trends in CKD-specific CPM's. Study subjects: Beneficiaries from the VHA will be included in one of a series of annual cohorts, dating from 2000 to 2005, if they have laboratory evidence for reduced renal function defined by an estimated glomerular filtration rate (GFR) of = 60 ml/min, during the year of inclusion. Alternative definitions of CKD will also be explored. Study measures: Subjects will be monitored for 12 months from the index measure of renal function for the occurrence of discrete CPM's. These performance indicators include several that are endorsed by K/DOQI and additional novel measures of practices to be avoided because of the potential for disease-specific medical risk, or threats to patient safety. The CPM's will be treated as binomial variables, expressed as proportions in the serial samples, and analyzed for trends over the proposed study years. Expected findings: Dissemination of practice guidelines in a large health care organization such as the VHA will lead to significant improvements in the recognition and care of persons with CKD, with significant favorable trends in the proposed CPM's over the designated study interval. This is a secondary analysis of VHA administrative and clinical data on veterans identified with chronic kidney disease over several years to assess the effect of practice guidelines on the quality of their disease-specific care.