MO479: CKD Coding Across Hertfordshire and West Essex. Are We Missing the Chance for Early Intervention?

Abstract

Abstract BACKGROUND AND AIMS Coding of chronic kidney disease (CKD) is associated with better outcomes through addressing the risk factors, and CKD-coded cases were found to have fewer unplanned hospital admission rates. We aim to compare the CKD coding across Hertfordshire and West Essex to the published CKD prevalence by Quality and Outcomes Framework (QOF) and New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA), and to demonstrate variation in coding across primary care practices within the region. METHOD In August 2020, we reviewed data for Clinical Commissioning Groups (CCG), Primary Care Networks (PCN), practice code and practice name. Data were obtained from 136/144 practices, including the numbers of adult patients, number of CKD-coded patients, and percentage as a total of the adult population by practice, PCN and CCG were derived. Then we compared the actual obtained data with predicted numbers and percentages of CKD patients estimated from practice-registered adult populations using QOF (2009–10) that demonstrated a 4.3% prevalence [1] and NEOERICA (2003) that demonstrated an 8.5% prevalence [2]. RESULTS Across the adult population of 1.2 million, 38 645 patients had a CKD code, giving a 3.2% CKD prevalence. Assuming a QOF of 4.3% prevalence, then 13 316 CKD patients are uncoded. While considering a NEOERICA 8.5% prevalence, this would yield the assumption of 64 160 CKD uncoded patients. East & North Hertfordshire NHS Trust had the lowest coded CKD percentage at 2.7% of the served adult population. All three CCG areas had considerable percentage variations in CKD coding across the 135 practices. CONCLUSION Across Hertfordshire and West Essex, CKD coding is below the published CKD prevalence from QOF and NEOERICA, suggesting significant numbers of patients are uncoded. There are variations in coding percentage between primary care practices within the PCN and CCG groups. Suboptimal coding may decrease the ability to offer early intervention to decrease CKD progression and would be associated with poor outcomes, including cardiovascular disease. This demonstrates the current unmet need for improved coding through community nephrology surveillance between primary and secondary care.