The Veteran’s Affairs (VA) data presented are from a national sample of health care visits to the VA Health System by eligible U. S. veterans. During any given year, roughly 70% of the outpatient population receives at least one serum creatinine test. While the demographics of VA Health System users are distinct from the general U.S. population, the VA data allow a snapshot of clinical practices across the nation.
National VA data were examined. Within each VISN (Veterans Integrated Service Network), a 5% random sample of patients was extracted from the national VA data repository each fiscal year (FY) from FY2005 to FY2009. Starting in FY2010 and continuing in future years, analyses were performed on the entire patient population (100% sample).
To examine acute kidney injury (AKI) in the hospital setting within the VA, we determined an index hospitalization for each fiscal year. This was the patient's first hospitalization of the year that had a length of stay of 2 days or more with 2 or more inpatient serum creatinine test results. A baseline serum creatinine measurement was determined from outpatient serum creatinine test results at least 7 days prior to the index hospitalization. Patients with evidence of pre-admission end-stage renal disease or a baseline MDRD estimated GFR less than 15 were excluded. An episode of AKI during the index hospitalization was defined by an increase in serum creatinine from baseline of 0.3mg/dL that did not decrease within 48 hours.
All outpatient visits between discharge and 6 months post discharge for patients alive 6 months after discharge were examined to see if the patient visited a nephrology clinic within the VA.
This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
|Description of Measure||Percentage of patients with in-hospital acute kidney injury as defined by Acute Kidney Injury Network (AKIN) criteria that had a nephrology clinic visit within the VA within 6 months following discharge|
|Type of Data Source||Administrative Data|
|Data Set||VA National 5% Sample (FY05-FY09) and 100% (FY10-present)|
|Health Care System Data||Yes|
|Regional or National?||National|
|Demographic Group||Patients using the VA health care system|
|Numerator||Patients in the denominator with a nephrology clinic visit within 6 months of discharge from the hospital stay where they experienced acute kidney injury|
|Denominator||Patients with an episode of AKI within their index hospitalization for the specified fiscal year who survived at least 6 months after discharge|
|Index Hospitalization||The patient's first hospital stay of 2 days or longer with at least 2 serum creatinine measurements during the specified fiscal year|
|Baseline kidney function||Baseline serum creatinine was designated as the lowest serum creatinine measurement less than 90 days before admission, but no closer than 7 days before admission. If there was no serum creatinine test result in the that time frame, baseline serum creatinine was designated as the closest test result to admission from tests performed 90 to 365 days before admission. If there still was no outpatient serum creatinine result for the patient, baseline serum creatinine was taken from outpatient results within 7 days of admission or the first inpatient serum creatinine.|
|Acute Kidney Injury Network criteria for AKI||
Note that only the serum creatinine criteria were used for this measure
|Primary Data Source Indicator||Nephrology clinic visit within 180 days of discharge|
|Limitations||Only nephrology visits at a VA medical center are included in this indicator. Since not all VA medical centers have nephrology clinics, some VA patients may see nephrologists outside of the VA. This may underestimate the true fraction of VA patients receiving nephrology care.|
References and Sources:
Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. Suppl. 2012;2(1):1-138..