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. 2023 Aug 29;7(5):382-391.
doi: 10.1016/j.mayocpiqo.2023.07.002. eCollection 2023 Oct.

Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes

Silvia Ferrè  1 , Amy Storfer-Isser  2 , Kelsy Kinderknecht  2 , Elizabeth Montgomery  1 , Miriam Godwin  1 , Ashby Andrews  1 , Stephan Dunning  3 , Mary Barton  2 , Dan Roman  2 , John Cuddeback  4 , Nikita Stempniewicz  4 , Chi D Chu  5 , Delphine S Tuot  5 , Joseph A Vassalotti  1   6
Affiliations

Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes

Silvia Ferrè et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To evaluate the fulfillment and validity of the kidney health evaluation for people with diabetes (KED) Healthcare Effectiveness Data Information Set (HEDIS) measure.

Patients and methods: Optum Labs Data Warehouse (OLDW) was used to identify the nationally distributed US population aged 18 years and older, with diabetes, between January 1, 2017, and December 31, 2017. The OLDW includes deidentified medical, pharmacy, laboratory, and electronic health record (EHR) data. The KED fulfillment was defined in 2017 as both estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio testing within the measurement year. The KED validity was assessed using bivariate analyses of KED fulfillment with diabetes care measures in 2017 and chronic kidney disease (CKD) diagnosis and evidence-based kidney protective interventions in 2018.

Results: Among eligible 5,635,619 Medicare fee-for-service beneficiaries, 736,875 Medicare advantage (MA) beneficiaries, and 660,987 commercial patients, KED fulfillment was 32.2%, 38.7%, and 37.7%, respectively. Albuminuria testing limited KED fulfillment with urinary albumin-creatinine ratio testing (<40%) and eGFR testing (>90%). The KED fulfillment was positively associated with receipt of diabetes care in 2017, CKD diagnosis in 2018, and evidence-based kidney protective interventions in 2018. The KED fulfillment trended lower for Black race, Medicare-Medicaid dual eligibility status, low neighborhood income, and low education status.

Conclusion: Less than 40% of adults with diabetes received guideline-recommended testing for CKD in 2017. Routine KED was associated with diabetes care and evidence-based CKD interventions. Increasing guideline-recommended testing for CKD among people with diabetes should lead to timely and equitable CKD detection and treatment.

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Conflict of interest statement

J.A.V. reports honoraria from Renalytix, PLC. (Advisory Board) and Astra Zenica, Inc. (consultant).

Figures

Figure
Figure
Use of CKD tests by health insurer. KED numerator fulfillment breakdown by test type across insurance types. KED, kidney health evaluation for people with diabetes; FFS, fee-for service; eGFR, estimated glomerular filtration rate; uACR, urine albumin-creatinine ratio.
See this image and copyright information in PMC

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