title: A Population-Based Analysis of Quality Indicators in CKD.
abstract: OBJECTIVE
  Awareness of CKD remains low in comparison with other chronic diseases, such as diabetes, leading to low use of preventive medications and appropriate testing. The objective of this study was to evaluate the quality of care provided to people with and at risk of CKD.
  
  
  METHODS
  We conducted a population-based analysis of all Albertans with eGFR=15-59 ml/min per 1.73 m2between April 1, 2011 and March 31, 2012 as well as patients with diabetes (as of March 31, 2012). We assessed multiple quality indicators in people with eGFR=15-59 ml/min per 1.73 m2, including appropriate risk stratification with albuminuria testing and preventive medication use and screened people with diabetes using urine albumin-to-creatinine ratio and serum creatinine measurements.
  
  
  RESULTS
  Among 96,480 adults with eGFR=15-59 ml/min per 1.73 m2, we found that 17.0% of those without diabetes were appropriately risk stratified with a measure of albuminuria compared with 64.2% of those with diabetes (P<0.001). Of those with eGFR=15-59 ml/min per 1.73 m2and moderate or severe albuminuria, 63.2% of those without diabetes received an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker compared with 82.1% in those with diabetes (P<0.001). Statin use was also significantly lower in patients with eGFR=15-59 ml/min per 1.73 m2without diabetes (39.2%) compared with those with diabetes (64.6%;P<0.001). Among 235,649 adults with diabetes, only 41.8% received a urine albumin-to-creatinine ratio and 73.2% received a serum creatinine measurement over 1 year.
  
  
  CONCLUSIONS
  We identified large gaps in care, especially in those with CKD but no diabetes. The largest gap was in the prescription of guideline-concordant medication in those with CKD as well as appropriate screening for albuminuria in those with diabetes. Our work illustrates the importance of measuring health system performance as the first step in a quality improvement process to improve care and outcomes in CKD.
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of.
authors.forename: Liam
authors.initials: L
authors.lastname: Manns
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of.|Medicine and.|Libin Cardiovascular Institute, and.|O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; and.|Alberta Health Services Kidney Health Strategic Clinical Network, Alberta, Canada.
authors.forename: Nairne
authors.initials: N
authors.lastname: Scott-Douglas
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of.|Medicine and.|Community Health Sciences.|Libin Cardiovascular Institute, and.|O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; and.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of.|Medicine and.
authors.forename: Robert
authors.initials: R
authors.lastname: Weaver
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of.|Community Health Sciences.
authors.forename: Helen
authors.initials: H
authors.lastname: Tam-Tham
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of.
authors.forename: Christy
authors.initials: C
authors.lastname: Chong
authors.affiliation: Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of.|Medicine and.|Community Health Sciences.|Libin Cardiovascular Institute, and.|O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; and.
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D000419:Albuminuria / Q000503:physiopathology / Q000628:therapy; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D000071836:Professional Practice Gaps; D019984:Quality Indicators, Health Care; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003404:Creatinine
keywords: Adult; Albumins; Angiotensin Receptor; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antagonists; Chronic Disease; Health Care Quality, Access, and Evaluation; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Kidney Function Tests; Quality Improvement; Quality Indicators, Health Care; Renal Insufficiency, Chronic; albuminuria; creatinine; diabetes mellitus