Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study.
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BACKGROUND: Automated reporting of estimated glomerular filtration rate (eGFR) is a recent advance in laboratory information technology (IT) that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kidney disease (CKD). Because accurate diagnosis of CKD is critical to optimal medical decision-making, several clinical practice guidelines have recommended the use of automated eGFR reporting. Since its introduction, automated eGFR reporting has not been uniformly implemented by U. S. laboratories despite the growing prevalence of CKD. CKD is highly prevalent within the Veterans Health Administration (VHA), and implementation of automated eGFR reporting within this integrated healthcare system has the potential to improve care. In July 2004, the VHA adopted automated eGFR reporting through a system-wide mandate for software implementation by individual VHA laboratories. This study examines the timing of software implementation by individual VHA laboratories and factors associated with implementation. METHODS: We performed a retrospective observational study of laboratories in VHA facilities from July 2004 to September 2009. Using laboratory data, we identified the status of implementation of automated eGFR reporting for each facility and the time to actual implementation from the date the VHA adopted its policy for automated eGFR reporting. Using survey and administrative data, we assessed facility organizational characteristics associated with implementation of automated eGFR reporting via bivariate analyses. RESULTS: Of 104 VHA laboratories, 88% implemented automated eGFR reporting in existing laboratory IT systems by the end of the study period. Time to initial implementation ranged from 0.2 to 4.0 years with a median of 1.8 years. All VHA facilities with on-site dialysis units implemented the eGFR software (52%, p<0.001). Other organizational characteristics were not statistically significant. CONCLUSIONS: The VHA did not have uniform implementation of automated eGFR reporting across its facilities. Facility-level organizational characteristics were not associated with implementation, and this suggests that decisions for implementation of this software are not related to facility-level quality improvement measures. Additional studies on implementation of laboratory IT, such as automated eGFR reporting, could identify factors that are related to more timely implementation and lead to better healthcare delivery.
SubjectHealth Plan Implementation
Medical Records Systems, Computerized
Practice Guidelines as Topic
Practice Patterns, Physicians'
Renal Insufficiency, Chronic
United States Department of Veterans Affairs
Published Version (Please cite this version)10.1186/1472-6947-12-69
Publication InfoHall, RK; Hammill, Bradley Gordon; Jackson, GL; Maciejewski, Matthew Leonard; Patel, Uptal Dinesh; Svetkey, LP; ... Yano, EM (2012). Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study. BMC Med Inform Decis Mak, 12. pp. 69. 10.1186/1472-6947-12-69. Retrieved from http://hdl.handle.net/10161/10411.
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Associate Professor in Population Health Sciences
Areas of expertise: Health Services Research, Health Policy, and Epidemiology
Professor in Population Health Sciences
Matt Maciejewski, PhD is a Professor in the Department of Population Health Sciences. He is also a Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care at the Durham VA Medical Center. Matt also holds Adjunct Professor appointments in the Schools of Public Health and Pharmacy at the University of North Carolina at Chapel Hill. He has research interests in four areas: 1) evaluation of sur
Adjunct Professor in the Department of Medicine
Uptal Patel, MD is an Adjunct Professor interested in population health with a broad range of clinical and research experience. As an adult and pediatric nephrologist with training in health services and epidemiology, his work seeks to improve population health for patients with kidney diseases through improvements in prevention, diagnosis and treatment. Prior efforts focused on four inter-related areas that are essential to improving kidney health: i) reducing the progressi
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