Brian Brady

All Publications

• Chronic kidney disease in older adults: challenges and opportunities for the primary care provider. BMC primary care Brady, B. M., Suffoletto, J. A., Sankary, R., Chertow, G. M. 2024; 25 (1): 388

  Abstract

  Kidney disease and its comorbidities disproportionately affect older persons. Kidney disease modifying therapy is underutilized in older adults, as guidelines lack consensus on approaching diagnosis and treatment in older adults. This review aims to highlight the challenges presented by, and opportunities for, identifying and treating CKD in older adults.

  View details for DOI 10.1186/s12875-024-02638-4

  View details for PubMedID 39487419

  View details for PubMedCentralID PMC11529074

• Patient-Reported Experiences with Dialysis Care and Provider Visit Frequency. Clinical journal of the American Society of Nephrology : CJASN Brady, B. M., Zhao, B., Dang, B. N., Winkelmayer, W. C., Chertow, G. M., Erickson, K. F. 2021; 16 (7): 1052-1060

  Abstract

  New payment models resulting from the Advancing American Kidney Health initiative may create incentives for nephrologists to focus less on face-to-face in-center hemodialysis visits. This study aimed to understand whether more frequent nephrology practitioner dialysis visits improved patient experience and could help inform future policy.In a cross-sectional study of patients receiving dialysis from April 1, 2015 through January 31, 2016, we linked patient records from a national kidney failure registry to patient experience data from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems survey. We used a multivariable mixed effects linear regression model to examine the association between nephrology practitioner visit frequency and patient-reported experiences with nephrologist care.Among 5125 US dialysis facilities, 2981 (58%) had ≥30 In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems surveys completed between April 2015 and January 2016, and 243,324 patients receiving care within these facilities had Medicare Parts A/B coverage. Face-to-face practitioner visits per month were 71% with four or more visits, 17% with two to three visits, 4% with one visit, and 8% with no visits. Each 10% absolute greater proportion of patients seen by their nephrology practitioner(s) four or more times per month was associated with a modestly but statistically significant lower score of patient experience with nephrologist care by -0.3 points (95% confidence interval, -0.5 to -0.1) and no effect on experience with other domains of dialysis care.In an analysis of patient experiences at the dialysis facility level, frequent nephrology practitioner visits to facilities where patients undergo outpatient hemodialysis were not associated with better patient experiences.

  View details for DOI 10.2215/CJN.16621020

  View details for PubMedID 34597265

  View details for PubMedCentralID PMC8425623

• Measuring Patient Experience with Home Dialysis in the United States. Clinical journal of the American Society of Nephrology : CJASN Brady, B. M., Kurella Tamura, M. n. 2021

  View details for DOI 10.2215/CJN.01990221

  View details for PubMedID 33788703

• Prevalence of impaired kidney function in patients with long-term lithium-treatment: a systematic review and meta-analysis. Bipolar disorders Schoretsanitis, G., de Filippis, R., Brady, B. M., Homan, P., Suppes, T., Kane, J. M. 2021

  Abstract

  Although lithium renal effects have been extensively investigated, prevalence rates of chronic kidney disease (CKD) in lithium-treated patients vary. Our aim was to provide prevalence estimates and related moderators.We performed a systematic review in PubMed/Embase until 11/01/2021, conducting a random-effects meta-analysis of studies evaluating CKD prevalence rates in lithium-treated patients calculating overall prevalence±95% confidence intervals (CIs). Meta-regression analyses included sex, age, body mass index, smoking, hypertension, diabetes, cardiovascular disease, lithium-treatment dose, duration and blood levels. Subgroup analyses included sample size, diagnoses and study design. Pooled odds ratios (OR) were estimated for studies including patients receiving non-lithium-treatment. Study quality was assessed using the Newcastle-Ottawa-scale.Five, nine and six trials were rated as high-, fair- and low-quality respectively. In 20 studies (n=25,907 patients) we estimated an overall prevalence of 25.5% (95%CI=19.8-32.2) of impaired kidney function; despite lack of differences (p=0.18), prevalence rates were higher in elderly samples than mixed samples of elderly and non-elderly (35.6%, 95%CI=21.4-52.9, k=2, n=3,161 vs. 25.1%, 95%CI=19.1-31.3, k=18, n=22,746). Prevalence rates were associated with longer lithium-treatment duration (p=0.04). Cross-sectional studies provided lower rates than retrospective studies (14.5%, 95%CI=13.5-15.5, k=6, n=4,758 vs. 29.5%, 95%CI=22.1-38.0, k=12, n=17,988, p<0.001). Compared to 722,529 patients receiving non-lithium-treatment, the OR of impaired kidney function in 14,187 lithium-treated patients was 2.09 (95%CI=1.24-3.51, k=8, p=0.005).One fourth of patients receiving long-term lithium may develop impaired kidney function, although research suffers from substantial heterogeneity between studies. This risk may be two-fold higher compared to non-lithium-treatment and may increase for longer lithium-treatment duration.

  View details for DOI 10.1111/bdi.13154

  View details for PubMedID 34783413

• Revealing Novel IDEAS: A Fiduciary Framework for Team-Based Prescribing. Academic medicine : journal of the Association of American Medical Colleges Plowman, R. S., Peters, S. R., Brady, B. M., Osterberg, L. G. 2019

  Abstract

  The importance of safe, effective, and cost-effective prescribing habits can hardly be overstated in the current pay-for-value environment. The prescribing process taught in most medical curricula focuses primarily on accurate medical indications. While this may be of utmost importance from the clinician's perspective, it falls short of addressing the other key elements of highly effective prescribing. These other elements are often paramount in the minds of patients. A patient-centric framework that associates and incorporates the necessary components of optimal prescribing is overdue. Building this framework into medical curricula will foster increased teamwork among providers and enhance shared decision making between patients and clinicians. In addition to establishing accurate medical indications, prescribing teams need to assure every prescribed medication is desired, effective, affordable, and safe for patients who receive them. Prescription writing is an honorable prerogative and doing so safely, effectively, and cost-effectively requires both teamwork and technology. Highly effective prescribing teams can implement the IDEAS (Indicated, Desired, Effective, Affordable, Safe) framework through appropriate and deliberate delegation. By empowering members of the care team to support and educate patients, this framework will allow physicians to focus on ensuring appropriate indications and real-world effectiveness. This novel IDEAS framework serves as an important mental model for medical trainees and reinforces sound prescribing habits among seasoned clinicians. High-touch and high-tech partnerships have the potential to maximize the triple aim (i.e., improving the patient's experience of care, improving the health of populations, and reducing the per capita cost of health care). In an era when costs overwhelm quality, providing a fiduciary framework to instill responsibility for optimal prescribing, especially among young physician-leaders, is invaluable.

  View details for DOI 10.1097/ACM.0000000000003100

  View details for PubMedID 31789844

• Integrated Care in ESKD A Perspective of Nephrologists CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Brady, B. M., Erickson, K. F. 2019; 14 (3): 451–53

  View details for DOI 10.2215/CJN.13081118

  View details for Web of Science ID 000460757600021

• Systems Delivery Innovation for Alzheimer Disease AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Bott, N. T., Sheckter, C. C., Yang, D., Peters, S., Brady, B., Plowman, S., Borson, S., Leff, B., Kaplan, R. M., Platchek, T., Milstein, A. 2019; 27 (2): 149–61

  View details for DOI 10.1016/j.jagp.2018.09.015

  View details for Web of Science ID 000455373700006

• Exploring Care Attributes of Nephrologists Ranking Favorably on Measures of Value. Journal of the American Society of Nephrology : JASN Brady, B. M., Ragavan, M. V., Simon, M. n., Chertow, G. M., Milstein, A. n. 2019

  Abstract

  Despite growth in value-based payment, attributes of nephrology care associated with payer-defined value remains unexplored.Using national health insurance claims data from private preferred provider organization plans, we ranked nephrology practices using total cost of care and a composite of common quality metrics. Blinded to practice rankings, we conducted site visits at four highly ranked and three average ranked practices to identify care attributes more frequently present in highly ranked practices. A panel of nephrologists used a modified Delphi method to score each distinguishing attribute on its potential to affect quality and cost of care and ease of transfer to other nephrology practices.Compared with average-value peers, high-value practices were located in areas with a relatively higher proportion of black and Hispanic patients and a lower proportion of patients aged >65 years. Mean risk-adjusted per capita monthly total spending was 24% lower for high-value practices. Twelve attributes comprising five general themes were observed more frequently in high-value nephrology practices: preventing near-term costly health crises, supporting patient self-care, maximizing effectiveness of office visits, selecting cost-effective diagnostic and treatment options, and developing infrastructure to support high-value care. The Delphi panel rated four attributes highly on effect and transferability: rapidly adjustable office visit frequency for unstable patients, close monitoring and management to preserve kidney function, early planning for vascular access, and education to support self-management at every contact.Findings from this small-scale exploratory study may serve as a starting point for nephrologists seeking to improve on payer-specified value measures.

  View details for DOI 10.1681/ASN.2019030219

  View details for PubMedID 31727849

• Patient-Reported Experiences of Dialysis Care Within a National Pay-for-Performance System JAMA INTERNAL MEDICINE Brady, B. M., Zhao, B., Niu, J., Winkelmayer, W. C., Milstein, A., Chertow, G. M., Erickson, K. F. 2018; 178 (10): 1358–67

  View details for DOI 10.1001/jamainternmed.2018.3756

  View details for Web of Science ID 000446453500012