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American Journal of Medical Quality
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Opportunities for Improving Management of Advanced Chronic Kidney Disease

Meenal B. Patwardhan, MD, MHSA

Duke Center for Clinical Health Policy Research, Duke University Medical Center, and Veterans Administration Health Services Research, mechpatw{at}gmail.com

David B. Matchar, MD

Duke Center for Clinical Health Policy Research, Duke University Medical Center, and Veterans Administration Health Services Research

Gregory P. Samsa, PhD

Duke Center for Clinical Health Policy Research, Duke University Medical Center, and Department of Biostatistics and Bioinformatics, Duke University

William E. Haley, MD

Mayo Clinic College of Medicine, Rochester, Minnesota and Mayo Clinic Division of Nephrology and Hypertension, Jacksonville, Florida

Evidence suggests that management of advanced chronic kidney disease affects patient outcomes. To identify clinical areas that demand attention from a quality improvement perspective, we sought to examine the extent of conformance to an advanced chronic kidney disease guideline in a range of practices. A total of 237 patient medical records were abstracted from 4 primary care providers and 4 nephrology private practices across the country. In the practices studied, management of advanced chronic kidney disease patients was suboptimal for patients managed by primary care providers as well as those managed by nephrologists (overall conformance 27% and 42%, respectively), specifically for anemia, bone disease, and timing for renal replacement therapy. The current exercise (in conjunction with a literature search and focused and individual interviews with providers and patients) offered valuable information that was used to develop a toolkit for optimizing management of advanced chronic kidney disease. (Am J Med Qual 2008;23:184-192)

Key Words: chronic kidney disease • guideline conformance • practice patterns

American Journal of Medical Quality, Vol. 23, No. 3, 184-192 (2008)
DOI: 10.1177/1062860608314985
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