Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Q7, Cleveland Clinic, Cleveland, OH 44195, USA.
Clin J Am Soc Nephrol. 2011 Jan;6(1):40-9. doi: 10.2215/CJN.04230510. Epub 2010 Nov 4.
Chronic kidney disease (CKD) is increasing, and outcomes-related research from diverse health care settings is needed to target appropriate efforts and interventions. We developed an electronic health record (EHR)-based CKD registry at the Cleveland Clinic and validated comorbid conditions.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients who had at least one face-to-face outpatient encounter with a Cleveland Clinic health care provider and (1) had two estimated GFR values <60 ml/min per 1.73 m(2) >90 days apart as of January 1, 2005 and/or (2) were patients with International Classification of Diseases-9 (ICD-9) diagnosis codes for kidney disease were included.
Our registry includes 57,276 patients (53,399 patients met estimated GFR criteria and 3877 patients met ICD-9 diagnosis code criteria) as of March 2010. Mean age was 69.5 ± 13.4 years, with 55% women and 12% African Americans. Medicare is the primary insurer for more than one half of the study cohort. The κ statistics to assess the extent of agreement between the administrative dataset extracted from the EHR and actual EHR chart review showed substantial agreement (>0.80) for all conditions except for coronary artery disease and hypertension, which had moderate agreement (<0.60).
Development of an EHR-based CKD registry is feasible in a large health system, and the comorbid conditions included in the registry are reliable. In addition to conducting research studies, such a registry could help to improve the quality of care delivered to CKD patients and complement the ongoing nationwide efforts to develop a CKD surveillance project.
慢性肾脏病（CKD）的发病率正在上升，需要从不同的医疗保健环境中获取与结局相关的研究结果，以便有针对性地开展适当的工作和干预措施。我们在克利夫兰诊所开发了一个基于电子病历（EHR）的 CKD 登记系统，并对合并症进行了验证。
设计、设置、参与者和测量方法：入选标准为：截至 2005 年 1 月 1 日，至少有一次克利夫兰诊所医疗服务提供者的面对面门诊就诊，且（1）两次估算肾小球滤过率（eGFR）值<60ml/min/1.73m2，且两次值之间间隔>90 天；或（2）符合国际疾病分类第 9 版（ICD-9）肾脏疾病诊断代码。
截至 2010 年 3 月，我们的登记系统共纳入 57276 例患者（53399 例符合 eGFR 标准，3877 例符合 ICD-9 诊断代码标准）。患者平均年龄为 69.5±13.4 岁，女性占 55%，非洲裔美国人占 12%。医疗保险是研究队列中超过一半患者的主要保险。从 EHR 中提取的行政数据集与实际 EHR 图表审查之间的κ统计数据显示，除了冠心病和高血压外，所有疾病的一致性都很高（>0.80），而冠心病和高血压的一致性为中度（<0.60）。
在大型医疗系统中建立基于 EHR 的 CKD 登记系统是可行的，且该登记系统中包含的合并症是可靠的。除了开展研究工作外，这种登记系统还有助于提高 CKD 患者的护理质量，并补充正在进行的全国范围内建立 CKD 监测项目的工作。
