Two years after a quality improvement intervention for chronic kidney disease care in a primary care office.

Implementation of evidence-based Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines is of increasing clinical importance. This study evaluates the long-term impact of a chronic kidney disease (CKD) quality improvement (QI) project. A retrospective chart review was performed at a family practice that completed a QI project 2 years previously. In a study population of 195 patients, CKD recognition decreased during the maintenance period from 70% to 60.8% (P = 1.98), from a baseline of 38.1%, and anemia recognition declined from 70% to 50% (P =.132), from a baseline of 35%. Evaluation for parathyroid hormone, vitamin D, and phosphate decreased from 44% to 33% (P =.216), from a baseline of 4.8%. Referrals to nephrologists decreased from 77% to 61% (P = .369), from a baseline of 14%. The decrement in KDOQI guideline compliance during the maintenance period was not statistically significant, nor was there a return to baseline values. This suggests that the intervention provided the education and reinforcement necessary to effect long-term change.

Constraints to caring: service to medically indigent patients by allopathic and osteopathic physicians.

Most U.S. physicians limit their care of medically indigent populations, rendering millions of patients underserved. Using survey data from a national sample of 669 allopathic and osteopathic physicians, this paper explores the professional, demographic, and attitudinal correlates of care of medically indigent (Medicaid and uninsured) patients. Separate bivariate and multivariate data analyses for allopathic and osteopathic physicians generate path models of the influences of physician characteristics on care of indigent patients. For both physician groups, professional characteristics such as practice type, location, medical specialty, and perceptions of the medical system shape care of indigent patients. Differential patterns of association emerge, with care provided by osteopathic physicians most significantly influenced by private practice, while medical specialty and employment in community clinics shapes indigent care provided by allopathic physicians. Results highlight the utility of comparative analyses in discerning the mechanisms through which professional characteristics influence indigent care by diverse health providers.