Abstract
Rational & ObjectiveElectronic health records can be leveraged to assess quality-of-care measures in patients with chronic kidney disease (CKD). Neighborhood socioeconomic status could be a potential barrier to receiving appropriate evidence-based therapy and follow-up. We examined whether neighborhood socioeconomic status is independently associated with quality of care received by patients with CKD.Study DesignObservational study using electronic health record data.Setting & ParticipantsRetrospective study of patients seen at a health care system in the 7-county Minneapolis/St Paul area.ExposuresCensus tract socioeconomic status measures (wealth, income, and education).OutcomesIndicators of CKD quality of care: (1) prescription for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in patients with stage ≥ 3 CKD or stage 1 or 2 CKD with urinary albumin-creatinine ratio (UACR) > 300 mg/d, (2) UACR measurement among patients with laboratory-based CKD (estimated glomerular filtration rate < 60 mL/min/1.72 m2), and (3) CKD identified on the problem list or coded for at an encounter among patients with laboratory-based CKD.Analytic ApproachMultilevel Poisson regression with robust error variance with a random intercept at the census tract level.ResultsOf the 16,776 patients who should be receiving an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 65% were prescribed these medications. Among patients with laboratory-based CKD (n = 25,097), UACR was measured in 27% and CKD was identified in the electronic health record in 55%. We found no independent association between any neighborhood socioeconomic status measures and CKD quality-of-care indicators.Limitations1 health care system and selection bias.ConclusionsWe found no association of neighborhood socioeconomic status with quality of CKD care in our cohort. However, adherence to CKD guidelines is low, indicating an opportunity to improve care for all patients regardless of neighborhood socioeconomic status.
Highlights
PLAIN-LANGUAGE SUMMARY Low neighborhood socioeconomic status may be a potential barrier for patients with chronic kidney disease to receive appropriate evidence-based medical therapy and follow-up
Our goal is to examine whether neighborhood socioeconomic status (SES) is associated with quality of care among patients with Chronic kidney disease (CKD) using Electronic health record (EHR) data from a large health care system
We found that only 35% of patients with hypertension and chronic kidney disease were not appropriately prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers
Summary
PLAIN-LANGUAGE SUMMARY Low neighborhood socioeconomic status may be a potential barrier for patients with chronic kidney disease to receive appropriate evidence-based medical therapy and follow-up. We leveraged electronic health record data from patients seen at a large health care system in Minnesota/St Paul. We found that only 35% of patients with hypertension and chronic kidney disease were not appropriately prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. In patients with chronic kidney disease, urinary albumin-creatinine ratio was measured in 27% of patients and only 55% had chronic kidney disease documented in their health record. We found no difference in any quality-of-care measure by neighborhood socioeconomic status in this cohort. There is room to improve evidence-based quality of kidney care
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