American Journal of Kidney Diseases
Volume 53, Issue 3, Supplement 3 , Pages S78-S85 , March 2009

CKD Screening and Management in the Veterans Health Administration: The Impact of System Organization and an Innovative Electronic Record

  • Thakor G. Patel, MD(Ret)

      Affiliations

    • Department of Veterans Affairs, Washington, DC
    • Corresponding Author InformationAddress correspondence to Thakor G. Patel, MD, 10980 Rice Field Pl, Fairfax Station, VA 22039
    • ,
  • Leonard M. Pogach, MD, MBA

      Affiliations

    • VA New Jersey Health Care System, East Orange, NJ
    • ,
  • Robert H. Barth, MD

      Affiliations

    • VA New York Harbor Healthcare System, Brooklyn, NY

References 

  1. Coresh J, Selvin E, Stevens L, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–2047
  2. US Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2007;Available at: www.usrds.org/adr.htm. Accessed May 11, 2008
  3. Miniño AM, Heron MP, Murphy SL, Kochanek KD Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System. Deaths: Final data for 2004. Natl Vital Stat Rep. 2007;55:1–119
  4. Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H. Outcomes in patients with chronic kidney disease referred late to nephrologists: A meta-analysis. Am J Med. 2007;120:1063–1070
  5. Coresh J, Byrd-Holt D, Astor BC, et al. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol. 2005;16:180–188
  6. Stevens LA, Fares G, Fleming James, et al. Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: Evidence for lack of physician awareness of chronic kidney disease. J Am Soc Nephrol. 2005;16:2439–2448
  7. National Institute of Diabetes and Digestive and Kidney Diseases. Healthy People 2010 Objectives: Chronic Kidney Disease. www2.niddk.nih.gov/AboutNIDDK/Organization/Divisions/KUH/KUHKidneyHP2010.htm2007;Accessed May 11, 2008
  8. Veterans Health Administration. VA Healthcare Statistics at a Glance. www1.va.gov/vha_oi/docs/VA_Healthcare_Statistics_at_a_Glance_2006.pdf2006;Accessed May 11, 2008
  9. Greenfield S, Kaplan SH. Creating a culture of quality: The remarkable transformation of the Department of Veterans Affairs Health Care System. Ann Intern Med. 2004;141:316–318
  10. Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med. 2003;348:2218–2227
  11. Kerr EA, Gerzoff RB, Krein SL, et al. Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: The TRIAD Study. Ann Intern Med. 2004;141:272–281
  12. Kern EF, Maney M, Miller DR, et al. Failure of ICD-9-CM codes to identify patients with comorbid chronic kidney disease in diabetes. Health Serv Res. 2006;41:564–580
  13. Sawin CT, Walder DJ, Bross DS, Pogach LM. Diabetes process and outcome measures in the Department of Veterans Affairs. Diabetes Care. 2004;27:SB90–SB94(suppl 2)
  14. Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med. 2001;135:825–834
  15. Murphy FM. Reinventing health care delivery in the 21st Century: What can we learn from innovations in federal government programs?. The 13th Princeton Conference, May 25, 2006 council.brandeis.edu/pubs/Prince13/MurphyPrinceton%20Conference%20May%202006final.pdfAccessed May 11, 2008
  16. Craig TJ, Perlin JB, Fleming BB. Self-reported performance improvement strategies of highly successful veterans health administration facilities. Am J Med Qual. 2007;22:438–444
  17. Goulet JL, Erdos J, Kancir S, et al. Measuring performance directly using the Veterans Health Administration electronic medical record: A comparison with external peer review. Med Care. 2007;45:73–79
  18. Kupersmith J, Francis J, Kerr E, et al. Advancing evidence-based care for diabetes: Lessons from the Veterans Health Administration. Health Affairs. 2007;26:w156–w158
  19. Curtis AC, Gillon J, Malmrose DC. Integration of longitudinal electronic records in a large healthcare enterprise: The U.S. Veterans Health Administration experience. Medinfo. 2007;12:367–371
  20. Choe HM, Mitrovich S, Dubay D, et al. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: A randomized controlled trial. Am J Manag Care. 2005;11:253–260
  21. VHA/DoD. Clinical Practice Guideline for Management of Chronic Kidney Disease and Pre-ESRD in Primary Care Setting. www.oqp.med.va.gov/cpg/ESRD/ESRD_GOL.htmMay 2001;Accessed May 11, 2008
  22. Fung CH, Woods JN, Asch SM, Glassman P, Doebbeling BN. Variation in implementation and use of computerized clinical reminders in an integrated healthcare system. Am J Manag Care. 2004;10:878–885
  23. Hysong SJ, Best RG, Pugh JA, Moore FI. Not of one mind: Mental models of clinical practice guidelines in the Veterans Health Administration. Health Serv Res. 2005;40:829–847
  24. Sequist TD, Gandhi TK, Karson AS, et al. A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc. 2005;12:431–437
  25. Saleem JJ, Patterson ES, Militello L, Render ML, Orshansky G, Asch SM. Exploring barriers and facilitators to the use of computerized clinical reminders. J Am Med Inform Assoc. 2005;12:438–447
  26. Lin ND, Martins SB, Chan AS, et al. Identifying barriers to hypertension guideline adherence using clinician feedback at the point of care. AMIA Annu Symp Proc 2006. 2006;494–498
  27. Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: The evidence that publishing patient care performance data improves quality of care. Ann Intern Med. 2008;148:111–123
  28. Hysong SJ, Best RG, Pugh JA. Audit and feedback and clinical practice guideline adherence: Making feedback actionable. Implement Sci. 2006;1:9

PII: S0272-6386(08)01728-9

doi: 10.1053/j.ajkd.2008.07.051

American Journal of Kidney Diseases
Volume 53, Issue 3, Supplement 3 , Pages S78-S85 , March 2009

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