Burden and Cost of Caring for US Veterans With CKD: Initial Findings From the VA Renal Information System (VA-REINS)

被引：17

作者：

Saran, Rajiv ^{[1
]}

Pearson, Aaron ^{[2
]}

Tilea, Anca ^{[3
]}

Shahinian, Vahakn ^{[1
]}

Bragg-Gresham, Jennifer ^{[1
]}

Heung, Michael ^{[1
]}

Hutton, David W. ^{[4
]}

Steffick, Diane ^{[1
]}

Zheng, Kai ^{[5
]}

Morgenstern, Hal ^{[6
,7
]}

Gillespie, Brenda W. ^{[2
]}

Leichtman, Alan ^{[1
]}

Young, Eric ^{[8
]}

O'Hare, Ann M. ^{[9
]}

Fischer, Michael ^{[10
]}

Hotchkiss, John ^{[11
]}

Siew, Eddie ^{[12
]}

Hynes, Denise ^{[13
]}

Fried, Linda ^{[14
]}

Balkovetz, Daniel ^{[15
]}

Sovern, Karen ^{[16
]}

Liu, Chuan-Fen ^{[17
]}

Crowley, Susan ^{[18
,19
]}

机构：

[1] Univ Michigan, Dept Internal Med Nephrol, Med Sch, Ann Arbor, MI 48109 USA

[2] Univ Michigan, Dept Biostat, Sch Publ Hlth, Ann Arbor, MI 48109 USA

[3] Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA

[4] Univ Michigan, Dept Hlth Management & Policy, Sch Publ Hlth, Ann Arbor, MI 48109 USA

[5] Univ Calif Irvine, Dept Informat, Irvine, CA USA

[6] Univ Michigan, Dept Epidemiol & Environm Hlth Sci, Sch Publ Hlth, Ann Arbor, MI 48109 USA

[7] Univ Michigan, Dept Urol, Med Sch, Ann Arbor, MI 48109 USA

[8] Arbor Res Collaborat Hlth, Ann Arbor, MI USA

[9] VA Puget Sound Hlth Care Syst, Dept Med Nephrol, Seattle, WA USA

[10] Hines VA Hosp, Ctr Innovat Complex Chron Healthcare, Hines, IL USA

[11] Pittsburgh VA Med Ctr, Dept Crit Care Med, Pittsburgh, PA USA

[12] Nashville VA Med Ctr, Div Nephrol & Hypertens, Nashville, TN USA

[13] VA Portland Hlth Care Syst, Portland, OR USA

[14] VA Pittsburgh Healthcare Syst, Ctr Hlth Equ Res & Promot, Pittsburgh, PA USA

[15] Birmingham VA Med Ctr, Birmingham, AL USA

[16] Ctr Off Analyt & Business Intelligence, Dept Vet Affairs, Seattle, WA USA

[17] VA Puget Sound Hlth Care Syst, Seattle, WA USA

[18] VA Connecticut Healthcare Syst, Sect Nephrol, West Haven, CT USA

[19] Yale Univ, Sch Med, New Haven, CT USA

来源：

AMERICAN JOURNAL OF KIDNEY DISEASES | 2021年 / 77卷 / 03期

关键词：

chronic kidney disease (CKD); CKD ascertainment; CKD prevalence; CKD registry; CKD surveillance; Electronic health record (EHR); end-stage renal disease (ESRD); health care costs; health information technology (HIT); learning health system; population health; population health management; quality improvement; registry;

D O I：

10.1053/j.ajkd.2020.07.013

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Kidney disease is a common, complex, costly, and life-limiting condition. Most kidney disease registries or information systems have been limited to single institutions or regions. A national US Department of Veterans Affairs (VA) Renal Information System (VA-REINS) was recently developed. We describe its creation and present key initial findings related to chronic kidney disease (CKD) without kidney replacement therapy (KRT). Data from the VA's Corporate Data Warehouse were processed and linked with national Medicare data for patients with CKD receiving KRT. Operational definitions for VA user, CKD, acute kidney injury, and kidney failure were developed. Among 7 million VA users in fiscal year 2014, CKD was identified using either a strict or liberal operational definition in 1.1 million (16.4%) and 2.5 million (36.3%) veterans, respectively. Most were identified using an estimated glomerular filtration rate laboratory phenotype, some through proteinuria assessment, and very few through International Classification of Diseases, Ninth Revision coding. The VA spent similar to$18 billion for the care of patients with CKD without KRT, most of which was for CKD stage 3, with higher perpatient costs by CKD stage. VA-REINS can be leveraged for disease surveillance, population health management, and improving the quality and value of care, thereby enhancing VA's capacity as a patient-centered learning health system for US veterans.

引用

页码：397 / 405

页数：9

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