November 29, 2018
2 min read

Study finds facility-level variations in diabetic CKD care within VA health system

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According to recently published results, facility-level variations were seen in kidney disease care within the Veterans Affairs health care system for patients with diabetes.

“Despite the ongoing best efforts to improve the care for veterans with diabetes and kidney disease, adherence to guideline-recommended core measures, such as ordering of certain laboratory tests, and scheduling of referrals to kidney specialists in eligible patients remains suboptimal, with modest facility-level variations for some measures and larger facility-level variation for others,” Sankar D. Navantheen MD, MS, MPH, told Healio Nephrology. “It is important to note that these rates are similar, if not better than other health care systems. Our results point out potential areas where additional efforts and programs could be implemented to address practice-level variations noted among VA facilities.”

Navantheen and colleagues identified 281,223 patients with diabetes and concomitant chronic kidney disease who received care in 130 facilities across the VA health care system. Investigators used median rate ratios and adjusted for various patient and provider-level factors to study the proportions of patients who received recommended core measures and to determine facility-level variations of the study outcomes. Study outcomes included measurement of urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio and blood hemoglobin concentration, prescription of statins and angiotensin converting enzyme inhibitors/angiotensin receptor blockers, BP,140/90 mm Hg, and referral to a VA nephrologist.

Results showed among patients with diabetes and stage 3 CKD (eGFR of 30 ml/min per 1.73 m²), the proportion of patients who received recommended core measures was 37% for urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio, was 74% for hemoglobin measurement, was 66% for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription, was 85% for statin prescription, was 47% for achieving blood pressure of less than 140/90 mm Hg and was 13% for patients who met all outcome measures. Investigators noted the adjusted median rate ratios for each measure were 5.2, 2.4, 1.3, 1.2, 1.4 and 4.1, respectively. In analysis redistricted to patients with stage 4 CKD (eGFR of 15 ml/min per 1.73 m² to 29 ml/min per 1.73 m²), the demonstrated median rate ratios were qualitatively similar to those of patients with stage 3 CKD. – by Monica Jaramillo


Disclosures: The study was supported by the American Heart Association Beginning grant-in-aid (14BGIA20460366 to S.S.V.), the American Diabetes Association Clinical Science and Epidemiology Award (1-14-CE-44 to S.S.V.), and the Houston Veterans Affairs Health Services Research and Development Center for Innovations Grant (CIN13- 413 to S.S.V.).