Table 6.

Estimated consequences of approaches (attribute 5): Population surveillance

Population Tracking/Monitoring	What Potential Barriers Would Delay the Process for Operationalizing the Approach?	Estimated Time to Systematically Address the Change across Data Sources? (months or years)
Creatinine-based GFR equations
USRDS	• Minimal effect because serum creatinine is reported in CMS Form 2728	NA
IHS	• Minimal effect because serum creatinine and eGFR without race correction are reported in the IHS Audit	NA
ICD/CPT codes data (e.g., from claims [Medicare, Optum], or EHRs [CURE-CKD, Kaiser])	• Lag in systematic revision and implementation of laboratory protocols/standards of care using the recommended eGFR approach • Lag in incorporating to the EHR/patient record • Potential inconsistency across the country in staging patients and reporting as the recommended eGFR equation is operationalized	Months to years
Survey data (NHANES)	• Minimal effect because serum creatinine is reported	NA
Creatinine/cystatin-based GFR equations
USRDS	• Lag in revising CMS 2728 Form • Lag in systematic implementation across multiple sources reporting to Medicare (revising laboratory protocols/standards of care using the recommended eGFR equation, procuring reagents, incorporating to the EHR/patient record) • Potential inconsistency in reporting from multiple data sources as the recommended GFR equation is operationalized	Months to years (depending on production and costs to estimate cystatin C)
IHS	• Lag in revising the IHS Audit form • Lag in systematic implementation across IHS	Months to years (depending on cystatin C production and costs)
ICD/CPT codes data (e.g., from claims [Medicare, Optum], or EHRs [CURE-CKD, Kaiser])	• Lag in systematic implementation across multiple data sources (revising laboratory protocols/standards of care using the recommended GFR approach, procuring reagents, incorporating to the EHR/patient record) • Potential inconsistency in reporting from multiple data sources as the recommended GFR approach is operationalized	Months to years (depending on cystatin C production and costs)
Survey data (NHANES)	• Lag in systematic implementation (revising laboratory [e.g., NHANES Nephrology Component] protocols, procuring reagents) • Lag in systematic programming for reporting cystatin C and in preparing survey analytic files	Years (depending on production and costs to estimate cystatin C)

USRDS, United States Renal Data System; CMS, Centers for Medicare and Medicaid Services; NA, not applicable; IHS, Indian Health Service; HER, electronic health record; CURE-CKD, Center for Kidney Disease Research, Education and Hope; NHANES, National Health and Nutrition Examination Survey.