title: An observational study of the quality of care for chronic kidney disease: a Buffalo and Albany, New York metropolitan area study.
abstract: BACKGROUND
  The database of a major regional health insurer was employed to identify the number and frequency of covered patients with chronic kidney disease (CKD). We then examined the characteristics of their care as defined, in part, by the frequency of physician visits and specialty referral, the characteristics of laboratory testing and total costs as indices of the quality of care of the subject population.
  
  
  METHODS
  This retrospective, cross-sectional study analyzed insurance claims, laboratory results and medication prescription data. Patients with two estimated glomerular filtration rate readings below 60 ml/min/1.73 m(2) (n = 20,388) were identified and classified by CKD stage.
  
  
  RESULTS
  The prevalence of CKD stages 3a and above was 12 %. Vascular comorbidities were common with prevalence increasing steadily from stage 3a through stage 5. Only 55.6 % of stage 4 CKD patients had claims for nephrology visits within one year of their index date. Fifty-nine percent of patients had claims for renin-angiotensin system (RAS) blockers. Twenty-five percent of patients in stage 3a CKD filled a prescription for non-steroidal anti-inflammatory drugs. Fifty-two percent of patients who developed end-stage renal disease received their first dialysis treatment as inpatients.
  
  
  CONCLUSIONS
  The pattern of medical practice observed highlights apparent deficiencies in the care of CKD patients including inappropriate medication use, delayed nephrology referral, and a lack of preparation for dialysis. This study shows the potential value of using large patient databases available through insurers to assess and likely improve regional CKD care.
authors.affiliation: State University of New York at Buffalo, School of Medicine and Biosciences, Buffalo, NY, 14215, USA. Pradeep.arora@va.gov.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Arora
authors.affiliation: State University of New York at Buffalo, School of Medicine and Biosciences, Buffalo, NY, 14215, USA. elkinp@buffalo.edu.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Elkin
authors.affiliation: Computer Task Group, Inc, 800 Delaware Avenue, Buffalo, NY, 14209, USA. josepheberle@outlook.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Eberle
authors.affiliation: Computer Task Group, Inc, 800 Delaware Avenue, Buffalo, NY, 14209, USA. jbono@ecmc.edu.
authors.forename: J James
authors.initials: JJ
authors.lastname: Bono
authors.affiliation: Computer Task Group, Inc, 800 Delaware Avenue, Buffalo, NY, 14209, USA. Laura.Argauer@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Argauer
authors.affiliation: State University of New York at Buffalo, School of Medicine and Biosciences, Buffalo, NY, 14215, USA. bmurray@ecmc.edu.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Murray
authors.affiliation: HealthNow New York, 257 West Genesee Street, Buffalo, NY, 14202, USA. raghuram@buffalo.edu.
authors.forename: Raghu
authors.initials: R
authors.lastname: Ram
authors.affiliation: State University of New York at Buffalo, School of Medicine and Biosciences, Buffalo, NY, 14215, USA. rvenuto@ecmc.edu.|Nephrology Department, 462 Grider Street, Buffalo, NY, 14215, USA. rvenuto@ecmc.edu.
authors.forename: Rocco C
authors.initials: RC
authors.lastname: Venuto
mesh_terms: D000368:Aged; D019411:Clinical Laboratory Techniques / Q000191:economics* / Q000706:statistics & numerical data; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011787:Quality of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies