Abstract: SA-PO853
Physician Practice Characteristics Associated with Quality of CKD Care
Session Information
- CKD: Socioeconomic Context and Mobile Apps
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Tummalapalli, Sri Lekha, University of California, San Francisco, San Francisco, California, United States
- Keyhani, Salomeh, San Francisco VA Health Care System, San Francisco, California, United States
- Estrella, Michelle M., University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, United States
Background
Improving the quality of CKD care has important implications for delaying disease progression and preventing ESKD. Understanding physician practice characteristics associated with high quality CKD care is critical to provide insight into effective care delivery for CKD.
Methods
We performed a serial cross-sectional study of visits to office-based ambulatory care practices for adults with diagnosed CKD using National Ambulatory Medical Care Survey data. Our predictors were physician practice characteristics: geographic region, metropolitan area, solo practice, type of specialty, practice ownership, employment status, and physician compensation. Outcomes were quality indicators: 1) uncontrolled hypertension; 2) uncontrolled diabetes; 3) ACEi/ARB use; and 4) statin use if age ≥50. Using multivariable logistic regression, we determined the association of physician practice characteristics with quality indicators, adjusting for patient age, sex, race, and comorbidities (hypertension, diabetes, congestive heart failure, and coronary artery disease).
Results
In 2006-2014, there were 9554 unweighted visits for CKD patients representing 232,899,670 weighted visits. Patients seen in medical specialty vs. primary care had nearly 2-fold odds of uncontrolled diabetes (95% CI: 1.11–2.86). Patients in metropolitan vs. non-metropolitan areas had higher use of ACEi/ARBs (41% vs. 33%, p=0.021), but there was no statistically significant association in adjusted analyses. CKD patients aged ≥50 seen in non-solo vs. solo practice had lower odds of statin use (aOR=0.81; 95% CI 0.66–0.99). Those seen in practices owned by insurance companies or health plans had 1.5-fold odds of statin use (95% CI 1.03–2.08), compared with practices with other ownership. Practice characteristics were otherwise not associated with CKD quality indicators.
Conclusion
In a nationally representative subset of outpatient visits for patients with diagnosed CKD, we found that few physician practice characteristics were associated with CKD quality indicators. Further studies are needed to determine optimal care delivery models based on practice-level characteristics.
Funding
- NIDDK Support