Kim Lois G, Caplin Ben, Cleary Faye, Hull Sally A, Griffith Kathryn, Wheeler David C, Nitsch Dorothea
Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Centre for Nephrology, UCL Medical School, London, UK.
Nephrol Dial Transplant. 2017 Apr 1;32(suppl_2):ii151-ii158. doi: 10.1093/ndt/gfw398.
Early diagnosis of chronic kidney disease (CKD) facilitates best management in primary care. Testing coverage of those at risk and translation into subsequent diagnostic coding will impact on observed CKD prevalence. Using initial data from 915 general practitioner (GP) practices taking part in a UK national audit, we seek to apply appropriate methods to identify outlying practices in terms of CKD stages 3-5 prevalence and diagnostic coding.
We estimate expected numbers of CKD stages 3-5 cases in each practice, adjusted for key practice characteristics, and further inflate the control limits to account for overdispersion related to unobserved factors (including unobserved risk factors for CKD, and between-practice differences in coding and testing).
GP practice prevalence of coded CKD stages 3-5 ranges from 0.04 to 7.8%. Practices differ considerably in coding of CKD in individuals where CKD is indicated following testing (ranging from 0 to 97% of those with and glomerular filtration rate <60 mL/min/1.73 m 2 ). After adjusting for risk factors and overdispersion, the number of 'extreme' practices is reduced from 29 to 2.6% for the low-coded CKD prevalence outcome, from 21 to 1% for high-uncoded CKD stage and from 22 to 2.4% for low total (coded and uncoded) CKD prevalence. Thirty-one practices are identified as outliers for at least one of these outcomes. These can then be categorized into practices needing to address testing, coding or data storage/transfer issues.
GP practice prevalence of coded CKD shows wide variation. Accounting for overdispersion is crucial in providing useful information about outlying practices for CKD prevalence.
慢性肾脏病（CKD）的早期诊断有助于在初级医疗保健中进行最佳管理。对高危人群的检测覆盖率以及后续转化为诊断编码将影响所观察到的CKD患病率。利用参与英国全国审计的915家全科医生（GP）诊所的初始数据，我们试图应用适当方法来识别在CKD 3 - 5期患病率和诊断编码方面的异常诊所。
我们估计每个诊所CKD 3 - 5期病例的预期数量，并根据关键的诊所特征进行调整，进一步扩大控制界限以考虑与未观察到的因素相关的过度离散（包括CKD的未观察到的危险因素以及编码和检测方面的诊所间差异）。
编码的CKD 3 - 5期在GP诊所中的患病率范围为0.04%至7.8%。在检测显示患有CKD的个体中，各诊所在CKD编码方面差异很大（肾小球滤过率<60 mL/min/1.73 m²的患者中，编码比例从0到97%不等）。在调整危险因素和过度离散后，对于低编码CKD患病率结果，“极端”诊所的数量从29家减少到2.6%，对于高未编码CKD阶段从21家减少到1%，对于低总（编码和未编码）CKD患病率从22家减少到2.4%。有31家诊所在这些结果中的至少一项上被确定为异常值。然后可以将这些诊所分类为需要解决检测、编码或数据存储/传输问题的诊所。
编码的CKD在GP诊所中的患病率差异很大。考虑过度离散对于提供有关CKD患病率异常诊所的有用信息至关重要。
