TY  - JOUR
TI  - Accounting for overdispersion when determining primary care outliers for the identification of chronic kidney disease: learning from the National Chronic Kidney Disease Audit
AV  - public
Y1  - 2017/02/17/
EP  - ii158
N2  - Background: 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 GP practices taking part in a UK national audit, we seek to apply appropriate methods to identify outlying practices in terms of CKD stage 3-5 prevalence and diagnostic coding. / Methods: We estimate expected numbers of CKD stage 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). / Results: GP practice prevalence of coded CKD stage 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 eGFR<60). 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 categorised into practices needing to address testing, coding or data storage/transfer issues. / Conclusion: GP practice prevalence of coded CKD shows wide variation. Accounting for overdispersion is crucial in providing useful information about outlying practices for CKD prevalence.
ID  - discovery1532867
KW  - Audit
KW  -  chronic kidney disease
KW  -  outliers
KW  -  overdispersion
KW  -  prevalence
SP  - ii151
VL  - 32
IS  - Supp 2
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
UR  - https://doi.org/10.1093/ndt/gfw398
SN  - 1312-5257
JF  - Nephrology, Dialysis and Transplantation
A1  - Caplin, BD
A1  - Kim, L
A1  - Cleary, F
A1  - Hull, S
A1  - Griffin, K
A1  - Wheeler, D
A1  - Nitsch, D
ER  -