Does better coding mean better care? A study of CKD coding and management indicators in Hampshire and Isle of Wight.

Abstract (English)

BACKGROUND: Chronic kidney disease (CKD) requires accurate identification and consistent management in primary care, but the extent to which coding accuracy reflects care quality across Hampshire and Isle of Wight (HIOW) practices remains uncertain. Accurate coding may support case finding and monitoring, yet whether improved coding aligns with better clinical management is unclear. AIM: To assess associations between practice-level CKD coding accuracy, care quality indicators, and socioeconomic deprivation across HIOW general practices. METHOD: An ecological cross-sectional study included 130 practices using publicly available data from CVD Prevent, NHS Digital, and the Ministry of Housing, Communities & Local Government. Aggregated variables comprised postcode, male patient percentage, proportion of uncoded CKD (primary outcome), blood pressure control, RAAS inhibitor prescribing, lipid-lowering therapy, and Index of Multiple Deprivation (IMD) rank. Spearman's rank correlation assessed non-parametric associations between uncoded CKD and predictors. Simple linear regressions were performed for each variable, followed by multiple regression incorporating significant univariable predictors, with residual diagnostics confirming model assumptions. RESULTS: Uncoded CKD ranged from 0.03% to 3.49% across practices, revealing wide variation. Correlations between uncoded CKD and IMD rank, male proportion, and management indicators were weak or absent. In multivariable analysis, no predictors were significantly associated with uncoded CKD rates. CONCLUSION: Better coding did not correspond with improved CKD management or care quality across practices. This suggests that factors beyond coding accuracy, such as practice processes and patient engagement, may have greater influence on care outcomes.