title: The long-term impact of eGFR reporting on referral patterns.
abstract: BACKGROUND
  The prognostic significance of CKD has driven the widespread introduction of automated estimated glomerular filtration rate (eGFR) reporting, and the incorporation of CKD in the revised Quality Outcomes Framework (QOF) of the General Medical Services (GMS) contract in the U.K.
  
  
  OBJECTIVE
  To assess the long-term impact of the introduction of these two initiatives, on patient referral numbers to a nephrology service.
  
  
  METHODS
  Data was collected on the numbers and basic characteristics of all new patients referred from April 2005 to March 2011, to one NHS Health Board.
  
  
  RESULTS
  Introduction of eGFR reporting and CKD QOF domains was associated with a significant increase in the number of referrals, which was sustained. The initiatives also led to a sustained increase in the mean age of the patients at referral, predominantly due to an increase in the age of female patients referred. There was also an increase in the proportion of female patients referred. In the immediate aftermath of the introduction of change there was a transient decrease in the average eGFR at referral, a decrease in age of patients referred with an eGFR <15ml/min and an increase in the eGFR of patients >70yrs of age.
  
  
  CONCLUSIONS
  The data demonstrates significant and sustained increase in numbers of referrals. In the short term this was associated with a reduction in referral of elderly patients with stage 5 CKD and an increase in elderly patients with mild renal impairment. In the longer term we saw an increase in referral of an older female population.
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: L A
authors.initials: LA
authors.lastname: Phillips
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Phillips
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: S
authors.initials: S
authors.lastname: Meran
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: J
authors.initials: J
authors.lastname: Russell
authors.affiliation: Department of Biochemistry and Immunology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK; Department of Medical Biochemistry, School of Medicine, Alexandria University, Egypt.
authors.forename: S
authors.initials: S
authors.lastname: Zouwail
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: S G
authors.initials: SG
authors.lastname: Riley
authors.affiliation: Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK. Electronic address: Phillipsao@cf.ac.uk.
authors.forename: A O
authors.initials: AO
authors.lastname: Phillips
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis*; D006113:United Kingdom
chemical_list: D003404:Creatinine
keywords: CKD; Impact; Referral; eGFR