Dataset Information

Trends in Quality of Care for Patients with CKD in the United States.

ABSTRACT: BACKGROUND AND OBJECTIVES:Improving the quality of CKD care has important public health implications to delay disease progression and prevent ESKD. National trends of the quality of CKD care are not well established. Furthermore, it is unknown whether gaps in quality of care are due to lack of physician awareness of CKD status of patients or other factors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We performed a national, serial, cross-sectional study of visits to office-based ambulatory care practices for adults with diagnosed CKD from the years 2006 to 2014. We assessed the following quality indicators: (1) BP measurement, (2) uncontrolled hypertension, (3) uncontrolled diabetes, (4) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use among patients with hypertension, (5) statin use if age ?50 years old, and (6) nonsteroidal anti-inflammatory drug use. Using multivariable linear regression and chi-squared analysis, we examined the change in quality performance over time. RESULTS:Between 2006 and 2014, there were 7099 unweighted visits for patients with CKD representing 186,961,565 weighted visits. There was no difference in the prevalence of uncontrolled hypertension (>130/80 mm Hg) over time (46% in 2006-2008 versus 48% in 2012-2014; P=0.50). There was a high prevalence of uncontrolled diabetes in 2012-2014 (40% for hemoglobin A1c >7%). The prevalence of ACEi/ARB use decreased from 45% in 2006-2008 to 36% in 2012-2014, which did not reach statistical significance (P=0.07). Statin use in patients with CKD who were 50 years or older was low and remained unchanged from 29% in 2006-2008 to 31% in 2012-2014 (P=0.92). CONCLUSIONS:In a nationally representative dataset, we found that patients with CKD had a high prevalence of uncontrolled hypertension and diabetes and a low use of statins that did not improve over time and was not concordant with guidelines.

SUBMITTER: Tummalapalli SL

PROVIDER: S-EPMC6682807 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Trends in Quality of Care for Patients with CKD in the United States.

Tummalapalli Sri Lekha SL Powe Neil R NR Keyhani Salomeh S

Clinical journal of the American Society of Nephrology : CJASN 20190711 8

<h4>Background and objectives</h4>Improving the quality of CKD care has important public health implications to delay disease progression and prevent ESKD. National trends of the quality of CKD care are not well established. Furthermore, it is unknown whether gaps in quality of care are due to lack of physician awareness of CKD status of patients or other factors.<h4>Design, setting, participants, & measurements</h4>We performed a national, serial, cross-sectional study of visits to office-based ...[more]

PMID: 31296503

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Project description:BACKGROUND:The objective of the study was to examine overall anemia management trends in non-dialysis patients with chronic kidney disease (CKD) from 2006 to 2015, and to evaluate the impact of Trial to Reduced Cardiovascular Events with Ananesp Therapy (TREAT)'s study results (October 2009) and the US Food and Drug Administration (FDA)'s (June 2011) safety warnings and guidelines on the use of ESA therapy in the current treatment of anemia. METHODS:A retrospective cohort analysis of anemia management in CKD patients using Truven MarketScan Commercial and Medicare Supplemental databases was conducted. Monthly rates and types of anemia treatment for post-TREAT and post-FDA safety warning periods were compared to pre-TREAT period. Anemia management included ESA, intravenous iron, and blood transfusion. A time-series analysis using Autoregressive Integrated Moving Average (ARIMA) model and a Generalized Estimating Equation (GEE) model were used. RESULTS:Between 2006 and 2015, CKD patients were increasingly less likely to be treated with ESAs, more likely to receive intravenous iron supplementation, and blood transfusions. The adjusted probabilities of prescribing ESAs were 31% (odds ratio (OR)?=?0.69, 95% confidence interval (CI): 0.67-0.71) and 59% (OR?=?0.41, 95% CI: 0.40, 0.42) lower in the post-TREAT and post-FDA warning periods compared to pre-TREAT period. The probability of prescribing intravenous iron was increased in the post-FDA warning period (OR?=?1.11, 95% CI: 1.03-1.19) although the increase was not statistically significant in the post-TREAT period (OR?=?1.03, 95% CI: 0.94-1.12). The probabilities of prescribing blood transfusion during the post-TREAT and post-FDA warning periods increased by 14% (OR?=?1.14, 95% CI: 1.06-1.23) and 31% (OR?=?1.31, 95% CI: 1.22-1.39), respectively. Similar trends of prescribing ESAs and iron supplementations were observed in commercially insured CKD patients but the use of blood transfusions did not increase. CONCLUSIONS:After the 2011 FDA safety warnings, the use of ESA continued to decrease while the use of iron supplementation continued to increase. The use of blood transfusions increased significantly in Medicare patients while it remained stable in commercially insured patients. Results suggest the TREAT publication had effected treatment of anemia prior to the FDA warning but the FDA warning solidified TREAT's recommendations for anemia treatment for non- dialysis dependent CKD patients.

Project description:Importance:Prior studies of dietary trends among US youth have evaluated major macronutrients or only a few foods or have used older data. Objective:To characterize trends in diet quality among US youth. Design, Setting, and Participants:Serial cross-sectional investigation using 24-hour dietary recalls from youth aged 2 to 19 years from 9 National Health and Nutrition Examination Survey (NHANES) cycles (1999-2016). Exposures:Calendar year and population sociodemographic characteristics. Main Outcomes and Measures:The primary outcomes were the survey-weighted, energy-adjusted mean consumption of dietary components and proportion meeting targets of the American Heart Association (AHA) 2020 continuous diet score (range, 0-50; based on total fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverages, and sodium). Additional outcomes were the AHA secondary score (range, 0-80; adding nuts, seeds, and legumes; processed meat; and saturated fat) and Healthy Eating Index (HEI) 2015 score (range, 0-100). Poor diet was defined as less than 40% adherence (scores, <20 for primary and <32 for secondary AHA scores); intermediate as 40% to 79.9% adherence (scores, 20-39.9 and 32-63.9, respectively); and ideal, as at least 80% adherence (scores, ?40 and ?64, respectively). Higher diet scores indicate better diet quality; a minimal clinically important difference has not been quantified. Results:Of 31?420 youth aged 2 to 19 years included, the mean age was 10.6 years; 49.1% were female. From 1999 to 2016, the estimated AHA primary diet score significantly increased from 14.8 (95% CI, 14.1-15.4) to 18.8 (95% CI, 18.1-19.6) (27.0% improvement), the estimated AHA secondary diet score from 29.2 (95% CI, 28.1-30.4) to 33.0 (95% CI, 32.0-33.9) (13.0% improvement), and the estimated HEI-2015 score from 44.6 (95% CI, 43.5-45.8) to 49.6 (95% CI, 48.5-50.8) (11.2% improvement) (P?<?.001 for trend for each). Based on the AHA primary diet score, the estimated proportion of youth with poor diets significantly declined from 76.8% (95% CI, 72.9%-80.2%) to 56.1% (95% CI, 51.4%-60.7%) and with intermediate diets significantly increased from 23.2% (95% CI, 19.8%-26.9%) to 43.7% (95% CI, 39.1%-48.3%) (P?<?.001 for trend for each). The estimated proportion meeting ideal quality significantly increased but remained low, from 0.07% (95% CI, 0.01%-0.49%) to 0.25% (95% CI, 0.10%-0.62%) (P?=?.03 for trend). Persistent dietary variations were identified across multiple sociodemographic groups. The estimated proportion of youth with a poor diet in 2015-2016 was 39.8% (95% CI, 35.1%-44.5%) for ages 2 to 5 years (unweighted n?=?666), 52.5% (95% CI, 46.4%-58.5%) for ages 6 to 11 years (unweighted n?=?1040), and 66.6% (95% CI, 61.4%-71.4%) for ages 12 to 19 years (unweighted n?=?1195), with persistent differences across levels of parental education, household income, and household food security status. Conclusions and Relevance:Based on serial NHANES surveys from 1999 to 2016, the estimated overall diet quality of US youth showed modest improvement, but more than half of youth still had poor-quality diets.

Project description:BackgroundAlthough many specialists serve as primary care physicians (PCPs), the type of patients they serve, the range of services they provide, and the quality of care they deliver is uncertain.ObjectiveTo describe trends in patient, physician, and visit characteristics, and compare visit-based quality for visits to generalists and specialists self-identified as PCPs.DesignCross-sectional study and time trend analysis.DataNationally representative sample of visits to office-based physicians from the National Ambulatory Medical Care Survey, 1997-2010.Main measuresProportions of primary care visits to generalist and specialists, patient characteristics, principal diagnoses, and quality.Key resultsAmong 84,041 visits to self-identified PCPs representing an estimated 4.0 billion visits, 91.5 % were to generalists, 5.9 % were to medical specialists and 2.6 % were to obstetrician/gynecologists. The proportion of PCP visits to generalists increased from 88.4 % in 1997 to 92.4 % in 2010, but decreased for medical specialists from 8.0 % to 4.8 %, p?=?0.04). The proportion of medical specialist visits in which the physician self-identified as the patient's PCP decreased from 30.6 % in 1997 to 9.8 % in 2010 (p?<?0.01). Medical specialist PCPs take care of older patients (mean age 61 years), and dedicate most of their visits to chronic disease management (51.0 %), while generalist PCPs see younger patients (mean age 55.4 years) most commonly for new problems (40.5 %). Obstetrician/gynecologists self-identified as PCPs see younger patients (mean age 38.3 p?<?0.01), primarily for preventive care (54.0 %, p?<?0.01). Quality of care for cardiovascular disease was better in visits to cardiologists than in visits to generalists, but was similar or better in visits to generalists compared to visits to other medical specialists.ConclusionsMedical specialists are less frequently serving as PCPs for their patients over time. Generalist, medical specialist, and obstetrician/gynecologist PCPs serve different primary care roles for different populations. Delivery redesign efforts must account for the evolving role of generalist and specialist PCPs in the delivery of primary care.

Project description:ObjectiveTo examine perceived inpatient care quality according to regional socioeconomic status (SES), measured by regional household income, across the United States and Taiwan.Data sourcesPatient Experience in Hospital Care (PEHC) survey 2018-2019 data from National Taiwan University; US Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) 2018-2019 data from CMS.gov; and household income and facility data from publicly accessible databases.Study designThis retrospective study used multivariate logistic regression to estimate the effect of household income on the rate of positive inpatient experiences in Taiwan and the United States, adjusting for hospitals' teaching status and ownership, and physician density.Data collectionHospital administrators for HCAHPS and PEHC's research teams invited patients who received inpatient care during the data collection period in the United States and Taiwan, respectively. The analysis included 1024 facilities from nine US states and 350 facilities from twenty major cities/counties in Taiwan.Principal findingsPerceived inpatient care quality was higher in the United States than in Taiwan for the three experience measures. In Taiwan, hospitals with higher regional SES were less likely to receive a highly positive response for perceived respect, accommodation quality, and understanding upon discharge, with odds ratios (ORs) ranging from 0.83 to 0.88. In contrast, in the United States, higher regional SES was associated with a higher likelihood of a positive response for accommodation quality and understanding upon discharge (ORs = 2.51 and 1.48). Regional physician density and individual hospital characteristics show varying effects on perceived quality between Taiwan and the United States.ConclusionsHigher overall experience scores in the United States are consistent with higher spending on health care compared with Taiwan. Varying associations between regional SES and perceived inpatient care quality highlight how systemic and cultural differences between the two countries affect scoring patterns.

Project description:Anemia is common in patients with advanced chronic kidney disease. Whereas the treatment of anemia in patients with end-stage renal disease (ESRD) has attracted considerable attention, relatively little is known about patterns and trends in the anemia care received by patients before they start maintenance dialysis or undergo preemptive kidney transplantation.To determine the trends in anemia treatment received by Medicare beneficiaries approaching ESRD.Closed cohort study in the United States using national ESRD registry data (US Renal Data System) of patients 67 years or older who initiated maintenance dialysis or underwent preemptive kidney transplantation between 1995 and 2010. All eligible patients had uninterrupted Medicare (A+B) coverage for at least 2 years before ESRD.Time, defined as calendar year of incident ESRD.Use of erythropoiesis-stimulating agents (ESA), intravenous iron supplements, and blood transfusions in the 2 years prior to ESRD; hemoglobin concentration at the time of ESRD. We used multivariable modified Poisson regression to estimate utilization prevalence ratios (PRs).Records of 466,803 patients were analyzed. The proportion of patients with incident ESRD receiving any ESA in the 2 years before increased from 3.2% in 1995 to a peak of 40.8% in 2007; thereafter, ESA use decreased modestly to 35.0% in 2010 (compared with 1995; PR, 9.85 [95% CI, 9.04-10.74]). Among patients who received an ESA, median time from first recorded ESA use to ESRD increased from 120 days in 1995 to 337 days in 2010. Intravenous iron administration increased from 1.2% (1995) to 12.3% (2010; PR, 9.20 [95% CI, 7.97-10.61]). The proportion of patients receiving any blood transfusions increased monotonically from 20.6% (1995) to 40.3% (2010; PR, 1.88 [95% CI, 1.82-1.95]). Mean hemoglobin concentrations were 9.5 g/dL in 1995, increased to a peak of 10.3 g/dL in 2006, and then decreased moderately to 9.9 g/dL in 2010.Between 1995 and 2010, older adults approaching ESRD were increasingly more likely to be treated with ESAs and to receive intravenous iron supplementation, but also more likely to receive blood transfusions.

Dataset Information

Trends in Quality of Care for Patients with CKD in the United States.

Publications

Trends in Quality of Care for Patients with CKD in the United States.

Similar Datasets

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