Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration System
Background Simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), that is, ‘dual testing,’ is an accepted quality measure in the management of diabetes. As chronic kidney disease (CKD) is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney ca...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-02-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/2/e073136.full |
| _version_ | 1797270746626523136 |
|---|---|
| author | Kara Zivin Meda E Pavkov Rajiv Saran Jennifer Bragg-Gresham Delphine Tuot Nicole M Bhave Yun Han Diane Steffick Nilka R Burrows Neil R Powe |
| author_facet | Kara Zivin Meda E Pavkov Rajiv Saran Jennifer Bragg-Gresham Delphine Tuot Nicole M Bhave Yun Han Diane Steffick Nilka R Burrows Neil R Powe |
| author_sort | Kara Zivin |
| collection | DOAJ |
| description | Background Simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), that is, ‘dual testing,’ is an accepted quality measure in the management of diabetes. As chronic kidney disease (CKD) is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney care.Objective We assessed time trends and facility-level variation in the performance of outpatient dual testing in the integrated Veterans Health Administration (VHA) system.Design, subjects and main measures This retrospective cohort study included patients with any inpatient or outpatient visit to the VHA system during the period 2009–2018. Dual testing was defined as UAlb and SCr testing in the outpatient setting within a calendar year. We assessed time trends in dual testing by demographics, comorbidities, high-risk (eg, diabetes) specialty care and facilities. A generalised linear mixed-effects model was applied to explore individual and facility-level predictors of receiving dual testing.Key results We analysed data from approximately 6.9 million veterans per year. Dual testing increased, on average, from 17.4% to 21.2%, but varied substantially among VHA centres (0.3%–43.7% in 2018). Dual testing was strongly associated with diabetes (OR 10.4, 95% CI 10.3 to 10.5, p<0.0001) and not associated with VHA centre complexity level. However, among patients with high-risk conditions including diabetes, <50% received dual testing in any given year. As compared with white veterans, black veterans were less likely to be tested after adjusting for other individual and facility characteristics (OR 0.93, 95% CI 0.92 to 0.93, p<0.0001).Conclusions Dual testing for CKD in high-risk specialties is increasing but remains low. This appears primarily due to low rates of testing for albuminuria. Promoting dual testing in high-risk patients will help to improve disease management and patient outcomes. |
| first_indexed | 2024-03-08T03:12:27Z |
| format | Article |
| id | doaj.art-1d029956bd424d488c5333a483b5ed47 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-25T02:09:10Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-1d029956bd424d488c5333a483b5ed472024-03-07T12:50:09ZengBMJ Publishing GroupBMJ Open2044-60552024-02-0114210.1136/bmjopen-2023-073136Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration SystemKara Zivin0Meda E Pavkov1Rajiv Saran2Jennifer Bragg-Gresham3Delphine Tuot4Nicole M Bhave5Yun Han6Diane Steffick7Nilka R Burrows8Neil R Powe9Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USADivision of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USADepartment of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USADepartment of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USADepartment of Medicine, Division of Nephrology, University of California San Francisco, San Francsisco, California, USADepartment of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USADepartment of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USADepartment of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USADivision of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USADepartment of Medicine, Division of Nephrology, University of California San Francisco, San Francsisco, California, USABackground Simultaneous urine testing for albumin (UAlb) and serum creatinine (SCr), that is, ‘dual testing,’ is an accepted quality measure in the management of diabetes. As chronic kidney disease (CKD) is defined by both UAlb and SCr testing, this approach could be more widely adopted in kidney care.Objective We assessed time trends and facility-level variation in the performance of outpatient dual testing in the integrated Veterans Health Administration (VHA) system.Design, subjects and main measures This retrospective cohort study included patients with any inpatient or outpatient visit to the VHA system during the period 2009–2018. Dual testing was defined as UAlb and SCr testing in the outpatient setting within a calendar year. We assessed time trends in dual testing by demographics, comorbidities, high-risk (eg, diabetes) specialty care and facilities. A generalised linear mixed-effects model was applied to explore individual and facility-level predictors of receiving dual testing.Key results We analysed data from approximately 6.9 million veterans per year. Dual testing increased, on average, from 17.4% to 21.2%, but varied substantially among VHA centres (0.3%–43.7% in 2018). Dual testing was strongly associated with diabetes (OR 10.4, 95% CI 10.3 to 10.5, p<0.0001) and not associated with VHA centre complexity level. However, among patients with high-risk conditions including diabetes, <50% received dual testing in any given year. As compared with white veterans, black veterans were less likely to be tested after adjusting for other individual and facility characteristics (OR 0.93, 95% CI 0.92 to 0.93, p<0.0001).Conclusions Dual testing for CKD in high-risk specialties is increasing but remains low. This appears primarily due to low rates of testing for albuminuria. Promoting dual testing in high-risk patients will help to improve disease management and patient outcomes.https://bmjopen.bmj.com/content/14/2/e073136.full |
| spellingShingle | Kara Zivin Meda E Pavkov Rajiv Saran Jennifer Bragg-Gresham Delphine Tuot Nicole M Bhave Yun Han Diane Steffick Nilka R Burrows Neil R Powe Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration System BMJ Open |
| title | Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration System |
| title_full | Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration System |
| title_fullStr | Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration System |
| title_full_unstemmed | Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration System |
| title_short | Assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine, 2009–2018: a retrospective cohort study in the Veterans Health Administration System |
| title_sort | assessing trends and variability in outpatient dual testing for chronic kidney disease with urine albumin and serum creatinine 2009 2018 a retrospective cohort study in the veterans health administration system |
| url | https://bmjopen.bmj.com/content/14/2/e073136.full |
| work_keys_str_mv | AT karazivin assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT medaepavkov assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT rajivsaran assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT jenniferbragggresham assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT delphinetuot assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT nicolembhave assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT yunhan assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT dianesteffick assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT nilkarburrows assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem AT neilrpowe assessingtrendsandvariabilityinoutpatientdualtestingforchronickidneydiseasewithurinealbuminandserumcreatinine20092018aretrospectivecohortstudyintheveteranshealthadministrationsystem |