Change in Referral Patterns to Nephrologists after Estimated Glomerular Filtration Rate (eGFR) Reporting: An interrupted time series analysis

Abstract

Objectives: To update a Cochrane review of interventions to improve outpatient referral and to assess changes in referrals to nephrologists after initiating automatic estimated glomerular filtration rate (eGFR) reporting. Methods: Systematic review using standardized Cochrane methods. Before and after study with interrupted time series analysis using data from retrospective chart review on referrals from family medicine to nephrology. Results: Review added one new study and removed one for total of 17 studies. Referrals improved with education and structured referral sheets. Of 2766 eligible referrals for one-year pre-eGFR reporting to one-year post, 96.6% were reviewed. There was a 68.2% increase in referrals for chronic kidney disease (P < 0.01) and a 64.1% increase in total appropriate referrals (P =0.01) with no significant change in proportion of appropriate referrals (-2.5%, P=0.56). Conclusion: Systematic review findings did not change from the previous review. eGFR reporting increased both appropriate and inappropriate referrals.