Long-Term quality-of-care score predicts incident chronic kidney disease in patients with type 2 diabetes

Pi I. Li, Jian Nan Wang, How-Ran Guo

Research output: Contribution to journalArticle

Abstract

Background Chronic kidney disease (CKD) is a common complication of diabetes, and requires long-Term medical care. However, besides the blood glucose level, no reliable method is currently available to link the quality of care and the development of CKD. We therefore developed a long-Term quality-of-care score for predicting the occurrence of CKD in patients with type 2 diabetes. Methods In this retrospective cohort study, using Taiwan's Longitudinal Cohort of Diabetes Patients Database and the medical records in a medical center, we identified incident patients with type 2 diabetes during 1999-2003 and followed them until 2011. A quality-of-care score (from 0 to 8) was calculated according to process indicators (frequencies of HbA1c and lipid profile testing and urine, foot, and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure, and HbA1c) and comorbidity of hypertension. We used Cox regression models to evaluate the association between the score and the incidence of CKD. Results Of the 4754 patients enrolled, 1407 developed CKD after a mean follow-up of 9.06 years. Compared with the risk of developing a CKD event in patients with scores ≤2, the risk was 69% lower in those with quality-of-care scores ≥5 (hazard ratio [HR] 0.31; 95% confidence interval [CI] 0.25-0.40) and 33% lower in those with scores between 3 and 4 (HR 0.67; 95% CI 0.59-0.77). Conclusions Good quality of care can reduce the risk of CKD in patients with type 2 diabetes. The score developed in this study had a significant association with the risk of CKD and thus can be applied to guide the care for these patients.

Original languageEnglish
Pages (from-to)2012-2019
Number of pages8
JournalNephrology Dialysis Transplantation
Volume33
Issue number11
DOIs
Publication statusPublished - 2018 Nov 1

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Quality of Health Care
Long-Term Care
Chronic Renal Insufficiency
Type 2 Diabetes Mellitus
Confidence Intervals
Diabetes Complications
Taiwan
LDL Lipoproteins
Proportional Hazards Models
Medical Records
Blood Glucose
Comorbidity
Foot
Patient Care
Cohort Studies
Retrospective Studies
Urine
Databases
Blood Pressure
Hypertension

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

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title = "Long-Term quality-of-care score predicts incident chronic kidney disease in patients with type 2 diabetes",
abstract = "Background Chronic kidney disease (CKD) is a common complication of diabetes, and requires long-Term medical care. However, besides the blood glucose level, no reliable method is currently available to link the quality of care and the development of CKD. We therefore developed a long-Term quality-of-care score for predicting the occurrence of CKD in patients with type 2 diabetes. Methods In this retrospective cohort study, using Taiwan's Longitudinal Cohort of Diabetes Patients Database and the medical records in a medical center, we identified incident patients with type 2 diabetes during 1999-2003 and followed them until 2011. A quality-of-care score (from 0 to 8) was calculated according to process indicators (frequencies of HbA1c and lipid profile testing and urine, foot, and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure, and HbA1c) and comorbidity of hypertension. We used Cox regression models to evaluate the association between the score and the incidence of CKD. Results Of the 4754 patients enrolled, 1407 developed CKD after a mean follow-up of 9.06 years. Compared with the risk of developing a CKD event in patients with scores ≤2, the risk was 69{\%} lower in those with quality-of-care scores ≥5 (hazard ratio [HR] 0.31; 95{\%} confidence interval [CI] 0.25-0.40) and 33{\%} lower in those with scores between 3 and 4 (HR 0.67; 95{\%} CI 0.59-0.77). Conclusions Good quality of care can reduce the risk of CKD in patients with type 2 diabetes. The score developed in this study had a significant association with the risk of CKD and thus can be applied to guide the care for these patients.",
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Long-Term quality-of-care score predicts incident chronic kidney disease in patients with type 2 diabetes. / Li, Pi I.; Wang, Jian Nan; Guo, How-Ran.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 11, 01.11.2018, p. 2012-2019.

Research output: Contribution to journalArticle

TY - JOUR

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AU - Li, Pi I.

AU - Wang, Jian Nan

AU - Guo, How-Ran

PY - 2018/11/1

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N2 - Background Chronic kidney disease (CKD) is a common complication of diabetes, and requires long-Term medical care. However, besides the blood glucose level, no reliable method is currently available to link the quality of care and the development of CKD. We therefore developed a long-Term quality-of-care score for predicting the occurrence of CKD in patients with type 2 diabetes. Methods In this retrospective cohort study, using Taiwan's Longitudinal Cohort of Diabetes Patients Database and the medical records in a medical center, we identified incident patients with type 2 diabetes during 1999-2003 and followed them until 2011. A quality-of-care score (from 0 to 8) was calculated according to process indicators (frequencies of HbA1c and lipid profile testing and urine, foot, and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure, and HbA1c) and comorbidity of hypertension. We used Cox regression models to evaluate the association between the score and the incidence of CKD. Results Of the 4754 patients enrolled, 1407 developed CKD after a mean follow-up of 9.06 years. Compared with the risk of developing a CKD event in patients with scores ≤2, the risk was 69% lower in those with quality-of-care scores ≥5 (hazard ratio [HR] 0.31; 95% confidence interval [CI] 0.25-0.40) and 33% lower in those with scores between 3 and 4 (HR 0.67; 95% CI 0.59-0.77). Conclusions Good quality of care can reduce the risk of CKD in patients with type 2 diabetes. The score developed in this study had a significant association with the risk of CKD and thus can be applied to guide the care for these patients.

AB - Background Chronic kidney disease (CKD) is a common complication of diabetes, and requires long-Term medical care. However, besides the blood glucose level, no reliable method is currently available to link the quality of care and the development of CKD. We therefore developed a long-Term quality-of-care score for predicting the occurrence of CKD in patients with type 2 diabetes. Methods In this retrospective cohort study, using Taiwan's Longitudinal Cohort of Diabetes Patients Database and the medical records in a medical center, we identified incident patients with type 2 diabetes during 1999-2003 and followed them until 2011. A quality-of-care score (from 0 to 8) was calculated according to process indicators (frequencies of HbA1c and lipid profile testing and urine, foot, and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure, and HbA1c) and comorbidity of hypertension. We used Cox regression models to evaluate the association between the score and the incidence of CKD. Results Of the 4754 patients enrolled, 1407 developed CKD after a mean follow-up of 9.06 years. Compared with the risk of developing a CKD event in patients with scores ≤2, the risk was 69% lower in those with quality-of-care scores ≥5 (hazard ratio [HR] 0.31; 95% confidence interval [CI] 0.25-0.40) and 33% lower in those with scores between 3 and 4 (HR 0.67; 95% CI 0.59-0.77). Conclusions Good quality of care can reduce the risk of CKD in patients with type 2 diabetes. The score developed in this study had a significant association with the risk of CKD and thus can be applied to guide the care for these patients.

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U2 - 10.1093/ndt/gfx375

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