title: Electronic problem list documentation of chronic kidney disease and quality of care.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is increasingly common and under-recognized in primary care clinics, leading to low rates of stage-appropriate monitoring and treatment. Our objective was to determine whether electronic problem list documentation of CKD is associated with monitoring and treatment.
  
  
  METHODS
  This is a cross-sectional observational study of patients with stage 3 or 4 CKD, defined as two past estimated glomerular filtration rates (eGFR) 15-60 mL/min/1.73 m2 separated by 90 days and collected between 2007-2008. We examined the association of problem list documentation with: 1) serum eGFR monitoring test, 2) urine protein or albumin monitoring test, 3) an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACE/ARB) prescription, 4) mean systolic blood pressure (BP), and 5) BP control.
  
  
  RESULTS
  Out of 3,149 patients with stage 3 or 4 CKD, only 16% of patients had CKD documented on the problem list. After adjustment for eGFR, gender, and race/ethnicity and after clustering by physician, problem list documentation of CKD was associated with serum eGFR testing (97% with problem list documentation vs. 94% without problem list documentation, p=0.02) and urine protein testing (47% with problem list documentation vs. 40% without problem list documentation, p=0.04). After adjustment, problem list documentation was not associated with ACE/ARB prescription, mean systolic BP, or BP control.
  
  
  CONCLUSIONS
  Documentation of CKD on the electronic problem list is rare. Patients with CKD documentation have better stage-appropriate monitoring of the disease, but do not have higher rates of blood pressure treatment or better blood pressure control. Interventions aimed at increasing documentation of CKD on the problem list may improve stage-appropriate monitoring, but may not improve clinical outcomes.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St,, Suite OBC-03-02 V, Boston, MA 02120, USA. LSAMAL@PARTNERS.ORG.
authors.forename: Lipika
authors.initials: L
authors.lastname: Samal
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
mesh_terms: D000368:Aged; D057189:Checklist / Q000592:standards* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004282:Documentation / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009398:Nephrology / Q000592:standards; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States