利用电子病历数据探索澳大利亚全科医疗中慢性肾脏病的筛查、诊断及管理
Exploration of chronic kidney disease screening, diagnosis and management in Australian general practice using electronic medical record data.
作者信息
Petzke Daniel, Hallinan Christine Mary, Trevena Judy, Manski-Nankervis Jo-Anne
机构信息
Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Department of Psychiatry, Monash University, Melbourne, Australia.
出版信息
BMC Nephrol. 2025 Jul 21;26(1):405. doi: 10.1186/s12882-025-04345-3.
BACKGROUND
CKD is a common but under-recognised condition that places significant burden on the individual and the health system globally. Our study applied a set of primary care quality indicators originally developed and validated using Canadian primary care data for screening, diagnosis and monitoring of CKD. These indicators were then applied to a large primary care dataset to assess CKD detection and management practices in Australia.
METHODS
We used de-identified data from the Patron repository, which contains data extracted from electronic medical records (EMRs) in Australian general practices. The 16 CKD indicators developed using Canadian EMR data were applied to this dataset. These indicators measured and reported on the use of clinical and pathological tests to diagnose and monitor CKD, the prescribing of antihypertensive and statin medications, and on rates of influenza immunisation.
RESULTS
Among the 362,078 unique patients identified across 78 general practices, 24,348 had a diagnosis or pathology consistent with CKD, of whom only 28.1% (6,841) had a diagnosis of CKD recorded. Of the 26,307 patients who initially presented with an eGFR below 60 ml/min/1.73m, 54.2% (14,254) underwent a repeat eGFR within six months and 28.8% (7,586) completed an ACR test. Of the patients recommended for screening based on the presence of risk factors, 76.1% had an eGFR performed within the last 18 months, whilst 34.2% had an ACR performed in the same period. Rates of monitoring of patients with CKD were slightly higher. A blood pressure had been recorded within the last 9 months in 71.1% of patients with CKD, and in 75.6% of the subset of patients with both diabetes and albuminuria. Around 45% of all patients with CKD were meeting their blood pressure targets at their last recording.
CONCLUSIONS
The results of this study demonstrate that it is feasible to derive meaningful and informative indicators of CKD diagnosis and management from primary care EMR data in Australia, which are comparable with international data. The low rates of CKD documentation and pathology monitoring provide opportunities for quality improvement initiatives to reduce disease burden.
CLINICAL TRIAL NUMBER
Not applicable.
背景
慢性肾脏病（CKD）是一种常见但未得到充分认识的疾病，给全球个人和卫生系统带来了沉重负担。我们的研究应用了一组最初使用加拿大初级保健数据开发并验证的初级保健质量指标，用于CKD的筛查、诊断和监测。然后将这些指标应用于一个大型初级保健数据集，以评估澳大利亚CKD的检测和管理实践。
方法
我们使用了Patron数据库中去识别化的数据，该数据库包含从澳大利亚全科医疗的电子病历（EMR）中提取的数据。使用加拿大EMR数据开发的16项CKD指标被应用于该数据集。这些指标测量并报告了用于诊断和监测CKD的临床和病理检查的使用情况、抗高血压和他汀类药物的处方情况以及流感疫苗接种率。
结果
在78家全科医疗机构中识别出的362,078名独特患者中，有24,348名患者的诊断或病理结果与CKD一致，其中只有28.1%（6,841名）有CKD诊断记录。在最初eGFR低于60 ml/min/1.73m²的26,307名患者中，54.2%（14,254名）在六个月内进行了重复eGFR检测，28.8%（7,586名）完成了ACR检测。在因存在风险因素而被推荐进行筛查的患者中，76.1%在过去18个月内进行了eGFR检测，而34.2%在同一时期进行了ACR检测。CKD患者的监测率略高。在过去9个月内，71.1%的CKD患者记录了血压，在患有糖尿病和蛋白尿的患者亚组中这一比例为75.6%。在最后一次记录时，所有CKD患者中约45%达到了血压目标。
结论
本研究结果表明，从澳大利亚初级保健EMR数据中得出有意义且信息丰富的CKD诊断和管理指标是可行的，这些指标与国际数据具有可比性。CKD记录和病理监测率较低为降低疾病负担的质量改进举措提供了机会。
临床试验编号
不适用。
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