Department of Nephrology, Kaiser Permanente Northwest, Portland, OR 97215, USA.
J Evid Based Med. 2012 Nov;5(4):194-204. doi: 10.1111/jebm.12005.
We attempted to: (1) to assess whether or not adequate evidence exists to advocate the measurement of anaemia in chronic kidney disease as a performance measure; and (2) to determine what the appropriate benchmarks might be for health systems seeking to implement this performance measure.
Our study was conducted in two phases: (1) we used the United States Preventive Service Task Force chain of evidence methodology to determine six key questions that were subsequently reviewed to determine if adequate evidence existed to recommend haemoglobin testing among patients with chronic kidney disease; and (2) in order to establish a benchmark for a potential performance measure we measured the number of patients who had a test for anaemia during the preceding year and during the preceding three years. We established these benchmarks using chronic kidney disease defined both by estimated glomerular filtration rate and ICD-9 codes.
Benchmarking was undertaken at Kaiser Permanente Northwest, which serves the Portland, Oregon and Vancouver, Washington metropolitan area, and Kaiser Permanente Georgia, which serves the Atlanta metropolitan area.
Patients with chronic kidney disease identified by either estimated glomerular filtration rate or ICD-9 code. MAIN OUTCOMES MEASUREMENT: Serum haemoglobin
This was an observational study.
Our review of the evidence found no direct evidence that testing for anaemia among patients with chronic kidney disease improved patient morbidity or mortality. The ideal test for anaemia was serum haemoglobin. We found that available treatments of anaemia improve fatigue, but may increase mortality and stoke. We also found that an overwhelming majority of patients with chronic kidney disease defined by either estimated glomerular filtration rate or ICD-9 codes, over one or three years had had a haemoglobin measurement.
There is currently inadequate evidence to recommend haemoglobin measurement among patients with chronic kidney disease as a performance measure. In addition, most patients with chronic kidney disease have already had haemoglobin measurement, minimizing the potential benefit of a performance measure.
我们试图：(1)评估是否有足够的证据支持将慢性肾脏病患者的贫血测量作为一项绩效指标；(2)确定健康系统在试图实施该绩效指标时，适当的基准可能是什么。
我们的研究分两个阶段进行：(1)我们使用美国预防服务工作组的证据链方法确定了六个关键问题，随后对这些问题进行了审查，以确定是否有足够的证据推荐慢性肾脏病患者进行血红蛋白检测；(2)为了建立一个潜在绩效指标的基准，我们测量了在前一年和前三年中接受贫血检测的患者数量。我们使用通过估计肾小球滤过率和 ICD-9 代码定义的慢性肾脏病来建立这些基准。
基准测试在 Kaiser Permanente Northwest 进行，该机构服务于俄勒冈州波特兰市和华盛顿州温哥华市大都市区，以及 Kaiser Permanente Georgia，服务于亚特兰大大都市区。
通过估计肾小球滤过率或 ICD-9 代码确定的慢性肾脏病患者。
血清血红蛋白。
这是一项观察性研究。
我们对证据的审查没有发现直接证据表明对慢性肾脏病患者进行贫血检测可以改善患者的发病率或死亡率。贫血的理想检测方法是血清血红蛋白。我们发现，贫血的可用治疗方法可以改善疲劳，但可能会增加死亡率和中风。我们还发现，在一到三年内，绝大多数通过估计肾小球滤过率或 ICD-9 代码定义的慢性肾脏病患者都进行了血红蛋白测量。
目前没有足够的证据推荐将慢性肾脏病患者的血红蛋白测量作为一项绩效指标。此外，大多数慢性肾脏病患者已经进行了血红蛋白测量，这最大限度地降低了绩效指标的潜在益处。
