Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study.
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2012-07-12
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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.
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Hall, Rasheeda K, Virginia Wang, George L Jackson, Bradley G Hammill, Matthew L Maciejewski, Elizabeth M Yano, Laura P Svetkey, Uptal D Patel, et al. (2012). Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study. BMC Med Inform Decis Mak, 12. p. 69. 10.1186/1472-6947-12-69 Retrieved from https://hdl.handle.net/10161/10411.
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Rasheeda Hall
I am a physician-scientist with an academic career focus is geriatric nephrology. The aim of my work is to transform the standard of care for vulnerable adults who have both advanced kidney disease and geriatric problems. I use epidemiology and health services research methodologies to identify effective novel interventions that integrate geriatric principles into kidney care settings. I lead a geriatric nephrology clinic at the Durham VA that integrates a brief geriatric assessment with kidney disease management and dialysis decision-making.
Virginia Wang
Dr. Virginia Wang is an Associate Professor in Population Health Sciences and Medicine at the Duke University School of Medicine and Core Faculty in the Duke-Margolis Center for Health Policy. She is also a Core Investigator in the Health Services Research Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Affairs Health Care System. Dr. Wang received her PhD in Health Policy and Management, with a focus on organizational behavior. Her research examines organizational influences and policy on the provision of health services, provider strategy and performance, care coordination, and outcomes for patients with complex chronic disease.
Dr. Wang’s research has been supported by the Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases, Department of Veterans Affairs, and the Centers for Medicare & Medicaid Services Office of Minority Health.
Areas of expertise: health services research, organizational behavior, health policy, implementation and program evaluationGeorge Lee Jackson
Areas of expertise: Epidemiology, Health Services Research, and Implementation Science
George L. Jackson, Ph.D., MHA is a healthcare epidemiologist and implementation scientist with a background in health administration. He joined the faculty of the UT Southwestern Medical Center in February of 2023 as a Professor and Director of the Advancing Implementation & Improvement Science Program in the Peter O'Donnell Jr. School of Public Health. Dr. Jackson is also a Veterans Affairs (VA) Health Services Research & Development (HSR&D) Research Health Scientist who works with the VA healthcare systems in both Durham, NC and Dallas, TX. He is the Director of the Implementation and Improvement Science Lab/Core at the Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). Additionally, he is a co-leader of a cooperative effort between the Dallas VA and Program on Implementation and Improvement Science designed to enhance the infrastructure for partnered health services and other research across the Dallas VA and UT Southwestern focused on enhancing the health and healthcare of Veterans in North Texas and across the Nation.
The UT Southwestern Advancing Implementation & Improvement Science Program seeks to further enhance collaborations between the UT Southwestern and affiliated health systems and community partners in the pursuit of common missions to enhance the health and healthcare of the people of North Texas. The goal is to develop a system to identify potentially successful projects using implementation and improvement science – which uses rigorous, data-driven research to expand programs and improve a community’s health.
Dr. Jackson’s own research and evaluation efforts focus on the development, testing, and implementation of team-based approaches to address the treatment and prevention of chronic conditions such as diabetes, hypertension, and cancer. He has also evaluated efforts to enhance the organization of mental health care. As an implementation scientist, Dr. Jackson studies strategies focused on the adoption and spread of evidence-informed practices across large health systems. He is currently the corresponding principal investigator for two VA program grants focused on the process of identifying, replicating, and spreading innovations across large healthcare systems. These include the Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) partnered evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence program and the Dynamic Diffusion Network (DDN) QUERI Program, both funded by the VA Quality Enhancement Research Initiative (QUERI).
Dr. Jackson received his Doctor of Philosophy (Ph.D.) in epidemiology, Master of Health Administration (MHA), and Bachelor of Science in Public Health (BSPH) in health policy and administration degrees from the School of Public Health at the University of North Carolina at Chapel Hill. He completed an Agency for Healthcare Research and Quality (AHRQ) pre-doctoral fellowship in health services research at the Cecil G. Sheps Center for Health Services Research and AHRQ post-doctoral fellowship in health services research in the Duke Division of General Internal Medicine and HSR&D Center at the Durham VA. He came to UT Southwestern from Duke University, where he was a Professor in the Departments of Population Health Sciences, Medicine (Division of General Internal Medicine), and Family Medicine & Community Health. He also co-taught evidence-based practice in the Duke Physician Assistant (PA) Program. Dr. Jackson currently maintains appointments as an Adjunct Professor of Population Health Sciences at Duke and Adjunct Professor of Health Policy and Management at the University of North Carolina at Chapel Hill.
Bradley Gordon Hammill
Brad Hammill, DrPH, is an Associate Professor in the Department of Population Health Sciences within the School of Medicine and a member of the Duke Clinical Research Institute. Dr. Hammill received his DrPH in Biostatistics from The University of North Carolina at Chapel Hill. His research is focused on leveraging real-world data—including electronic health record data, health insurance claims data, and registry data—for clinical research.
Areas of expertise: Biostatistics, Real-World Data, Health Services Research, Health Policy, and Epidemiology
Matthew Leonard Maciejewski
Matt Maciejewski, PhD is a Professor in the Department of Population Health Sciences. He is also a Senior Research Career Scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation 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 received funding from NIDDK, NIDA, CMS, AHRQ, VA HSR&D, and the RWJ Foundation to conduct evaluation of long-term clinical and economic outcomes of surgical interventions, behavioral interventions and Medicare program/policy changes on patients with obesity or cardiometabolic conditions. He is also interested in methods for addressing unobserved confounding in observational studies. Matt evaluated the first-ever population-based implementation of value-based insurance design and led the first-ever linkage of lab results and Medicare FFS claims. He has published over 300 papers in peer-reviewed journals such as JAMA, JAMA Internal Medicine, JAMA Surgery, Annals of Internal Medicine, Health Economics, Medical Care, and Health Services Research.
Areas of expertise: Health Services Research, Health Economics, Health Policy, Multimorbidity
Laura Pat Svetkey
Laura P. Svetkey, MD MHS is Professor of Medicine/Nephrology, Vice Chair for Faculty Development and Diversity in the Department of Medicine. She is also the Director of Duke’s CTSA-sponsored internal career development award program (KL2) and the Associate Director of Duke’s REACH Equity Disparities Research Center, in which she also leads the Investigator Development Core.
Dr. Svetkey has over 30 years of experience in the investigation of hypertension, obesity, and related areas, conducting NIH-sponsored clinical research ranging from behavioral intervention trials to metabolomics and genetics, with a consistent focus on prevention, non-pharmacologic intervention, health disparities and minority health. Her research has affected national guidelines, having served on the 2013 national Hypertension Guideline Panel (JNC) and the Lifestyle Guideline Working Group. She is an American Society of Hypertension certified hypertension specialist, and a member of the Association of American Physicians (AAP). She is the Associate Director, Core Director and Project PI of Duke’s NIH-sponsored REACH Equity Disparities Research Center (PI: Kimberly Johnson).
As Department of Medicine Vice Chair for Faculty Development and Diversity, she implements a wide range of programs to enhance the experience and advancement of faculty and trainees, with particular emphasis on those from racial and ethnic groups under-represented in medicine, and women.
Uptal Dinesh Patel
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 progression of chronic kidney disease by improving its detection and management, particularly by leveraging technology to facilitate engagement and self-management; ii) elucidating the inter-relationships between kidney disease and cardiovascular disease, which together amplify the risk of death; iii) improving the evidence in nephrology through comparative effectiveness research, including clinical trials, observational studies, and meta-analyses; and iv) promoting more optimal clinical health policy for all patients with kidney disease. These inter-disciplinary projects have been funded by a variety of public and private sources including the Robert Wood Johnson Foundation, Veterans Affairs, National Institutes of Health, Agency for Healthcare Research & Quality, Food and Drug Administration, Centers for Medicare & Medicaid Services, Renal Physicians Association, and the American Society of Nephrology.
Current efforts seek to advance novel therapies for kidney diseases through early clinical development that he leads at AstraZeneca.
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