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Study: Patients with abnormal kidney function are not getting timely follow-up
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A team of investigators studying electronic medical data on more than 200,000 adults found 58% of patients with a newly abnormal eGFR were not getting timely follow-up testing. Reasons for this are varied and include physician workload and electronic health record design, the researchers said.
“Lack of timely follow-up of abnormal test results can lead to diagnostic or treatment delays,” Kim N. Danforth, ScD, MPH, of the department of research and evaluation at Kaiser Permanente Southern California, said in National Kidney Foundation release on the study. “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.”
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 quantitative analyses were done with 244,540 patients in the Kaiser Permanente health care system who were 21 years or older with incident abnormal eGFRs from Jan. 1, 2010 to Dec. 31, 2015. The eGFR tests were ordered by 7,164 providers.
The results suggest 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.
As a result of the study, Kaiser Permanente Southern California will be adding a flag within the EHR for abnormal eGFR lab test results and working with physicians to develop systems to improve workflow, Danforth said.
“Timely follow-up of abnormal results remains challenging in an EHR-based integrated health care delivery system,” the authors concluded. “Strategies improving provider EHR message box management and leveraging health information technology (eg, flagging abnormal eGFR results), making organizational/staffing changes (eg, increasing the role of nurses in managing laboratory results), and boosting patient engagement through better patient portals may improve test follow-up.” –by Mark E. Neumann
Reference:
www.kidney.org/news/researchers-find-more-half-patients-newly-abnormal-kidney-function-tests-are-not-getting-timely.
Disclosures: This project was supported by grant number R01HS024437 from the Agency for Healthcare Research and Quality. The authors report no relevant financial disclosures.
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