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Accounting for overdispersion when determining primary care outliers for the identification of chronic kidney disease: learning from the National Chronic Kidney Disease Audit

Caplin, BD; Kim, L; Cleary, F; Hull, S; Griffin, K; Wheeler, D; Nitsch, D; (2017) Accounting for overdispersion when determining primary care outliers for the identification of chronic kidney disease: learning from the National Chronic Kidney Disease Audit. Nephrology, Dialysis and Transplantation , 32 (Supp 2) ii151-ii158. 10.1093/ndt/gfw398. Green open access

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Abstract

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.

Type: Article
Title: Accounting for overdispersion when determining primary care outliers for the identification of chronic kidney disease: learning from the National Chronic Kidney Disease Audit
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ndt/gfw398
Publisher version: https://doi.org/10.1093/ndt/gfw398
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Audit, chronic kidney disease, outliers, overdispersion, prevalence
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1532867
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