Paper cites reasons including physicians’ high workloads and electronic health record design as key challenges to patients getting timely follow-up tests
New York, NY - July 16, 2019 – A team of investigators studied electronic medical data on more than 200,000 of adults and found that 58 percent of patients with a newly abnormal estimated glomerular filtration rate (eGFR) were not getting timely follow-up testing after the abnormal result. Reasons for this are varied and include physicians’ workload and electronic health record design.
“Lack of timely follow-up of abnormal test results can lead to diagnostic or treatment delays,” said lead investigator Kim N. Danforth, ScD, MPH, of the Department of Research & Evaluation, Kaiser Permanente Southern California. “We sought to determine how frequently gaps in timely follow-up of abnormal creatinine/eGFR lab test results occur and to identify potential reasons for those gaps. Our goal was to identify ways to improve test follow-up in the future.”
An abnormal test result may indicate that the kidneys are not working as well as they should, but can also occur when the kidneys are healthy, and follow-up testing is needed to identify patients with kidney disease. The eGFR
test is the best way to estimate the level of kidney function and determine what further tests are needed. The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.
“Physicians reported high workloads and challenges managing lab test results within the electronic health record (EHR), which is important given growing concerns regarding burnout among primary care providers,” Danforth said. “Efficient processes for managing test results is critical.”
The investigators’ results suggest that better systems and processes are needed to support patients and providers in improving lab test follow-up, consistent with research in other health systems.
“Our study suggested that increasing team-based management of lab test results may help improve follow-up of abnormal results,” Danforth said.
“This important study should serve as a wakeup call for healthcare organizations nationwide, that ordering lab tests will only change patient outcomes if the results trigger action,” said NKF Chief Scientific Officer Kerry Willis, PhD. “NKF has developed a CKD Change Package
to assist providers in transforming their practices to meet this need.”
As a result of the study, Kaiser Permanente Southern California (KPSC) will be adding a flag within the electronic health records for abnormal eGFR lab test results and working with physicians to develop systems to improve workflow, Danforth said. KPSC also has an outpatient safety program, the SureNet Program, that was implemented in 2010. The program serves as a back-up system to notify patients when they are overdue for follow-up of an abnormal creatinine/eGFR test.
“These are things that could be considered by other lab and healthcare systems, as well,” she said.
While prior studies have shown that harm is rare in these patients due to the slow progression of disease, it is important to improve lab test follow-up, Danforth said. Despite automated notification of patients regarding overdue lab tests, there may be patient-related contributors to delayed or missed follow-up that are understudied. Future research is needed to improve patient engagement and determine which patients are at greatest risk of harm due to experiencing the gaps in follow-up care, Danforth said.
The investigators are Danforth; Erin E. Hahn, PhD, MPH; Jeffrey M. Slezak, MS; Lie Hong Chen, DrPH; Bonnie H. Li, MS; Corrine E. Munoz-Plaza, MPH; Tiffany Q. Luong, MPH; Teresa N. Harrison, SM; and Brian S. Mittman, PhD, all of the Department of Research & Evaluation, Kaiser Permanente Southern California; John J. Sim, MD, of the Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center; Hardeep Singh, MD, MPH, of the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, and Department of Medicine, Baylor College of Medicine, Houston; and Michael H. Kanter, MD, of Quality and Clinical Analysis, Southern California Permanente Medical Group, Pasadena, and the Kaiser Permanente School of Medicine, Pasadena, CA.
About the American Journal of Kidney Diseases
The American Journal of Kidney Diseases (AJKD), the official journal of the National Kidney Foundation, is recognized worldwide as a leading source of information devoted to clinical nephrology practice and clinical research. Articles selected for publication in AJKD must adhere to rigorous standards, supporting the journal's goal to communicate important new information in clinical nephrology in a way that strengthens knowledge and helps physicians to provide their patients with the highest standard of care.
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In the United States, 37 million adults are estimated to have chronic kidney disease (CKD) – and most aren’t aware of it. 1 in 3 American adults is at risk for CKD. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, a family history of kidney failure, and being age 60 or older. People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease. African Americans are about 3 times more likely than Whites to develop end-stage kidney disease (ESKD or kidney failure). Compared to non-Hispanics, Hispanics are almost 1.3 times more likely to receive a diagnosis of kidney failure.
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