title: Deficits in information transfer between hospital-based and primary-care physicians, the case of kidney disease: a cross-sectional study.
abstract: BACKGROUND
  Late recognition plays an important role in prognosis associated with kidney disease; thus, information transfer at hospital discharge regarding kidney disease is crucial. Whether it is notified in patients' hospital discharge summary (HDS) is presently largely unknown.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  The prevalence of kidney dysfunction [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)] and its reporting to primary-care physicians from 26 units [11 surgery, 11 medical, 4 intensive care units (ICUs)] of a university hospital were analyzed in 14,000 hospitalizations.
  
  
  METHODS
  eGFR.
  
  
  RESULTS
  Notification of kidney dysfunction in HDS.
  
  
  METHODS
  GFR was estimated from serum creatinine using the Modification of Diet in Renal Disease formula.
  
  
  RESULTS
  Kidney dysfunction was frequent (27.2 %) but infrequently notified in the main-body of the HDS (overall 25.3 %, medical 25 %, surgical 16.3 %, ICU 48.4 %) even when severe (eGFR 15-29.9 ml/min/1.73 m(2) was notified in 68.8, 38.5, and 79.8 % of HDSs in medical, surgical and ICUs, respectively). Notification in the HDS conclusion was rare (overall 11.4 %, medical 9.8 %, surgical 8.4 %, ICU 27.5 %). Reporting remained low when eGFR remained abnormal at discharge (medical 35.8 %, surgical 22.5 %, ICU 62.2 %) but was worse for acute kidney injury (16.0, 17.1, and 37.7 %, respectively). The optimal eGFR cut-off for reporting was 39 ml/min/1.73 m(2). Longer durations of hospitalization, greater numbers of creatinine measurements and of abnormal eGFR were associated with notification, regardless of the type of unit.
  
  
  CONCLUSIONS
  Lack of data to define acute or chronic kidney injury with precision.
  
  
  CONCLUSIONS
  Kidney dysfunction is frequent in hospitalized patients but is usually not notified, even when severe or still present at discharge, suggesting that it is not considered important to disclose to primary-care physicians. This lack of information may decrease physicians' awareness, and may affect continuity of care in patients with kidney dysfunction.
authors: Service de Néphrologie-Immunologie Clinique, CHU de Tours, Hôpital Bretonneau, 37044, Tours, France. benedicte.sautenet@univ-tours.fr.|Centre d'Investigation Clinique INSERM, CIC 1415, Tours, France. benedicte.sautenet@univ-tours.fr.|Université François-Rabelais, Tours, France. benedicte.sautenet@univ-tours.fr.
authors: Bénédicte
authors: B
authors: Sautenet
authors: Centre d'Investigation Clinique INSERM, CIC 1415, Tours, France.|Université François-Rabelais, Tours, France.
authors: Agnès
authors: A
authors: Caille
authors: Centre d'Investigation Clinique INSERM, CIC 1415, Tours, France.|Université François-Rabelais, Tours, France.
authors: Bruno
authors: B
authors: Giraudeau
authors: Centre d'Investigation Clinique INSERM, CIC 1415, Tours, France.
authors: Julie
authors: J
authors: Léger
authors: CHU de Tours, Laboratoire de Biochimie et Biologie Moléculaire, Tours, France.
authors: Patrick
authors: P
authors: Vourc'h
authors: Service de Néphrologie-Immunologie Clinique, CHU de Tours, Hôpital Bretonneau, 37044, Tours, France.|Université François-Rabelais, Tours, France.|EA 4245, Université François-Rabelais, Tours, France.
authors: Matthias
authors: M
authors: Buchler
authors: Service de Néphrologie-Immunologie Clinique, CHU de Tours, Hôpital Bretonneau, 37044, Tours, France.|Université François-Rabelais, Tours, France.|EA 4245, Université François-Rabelais, Tours, France.
authors: Jean-Michel
authors: JM
authors: Halimi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D063005:Health Information Systems / Q000458:organization & administration*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: Hospital discharge summary; Information; Kidney disease; Primary-care physician