Kidney Week

Abstract: FR-PO1103

Enhancing Access to Nephrology Care: Development of a Telenephrology Dashboard via Human-Centered Design

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Swee, Melissa L., VA Iowa City Healthcare System, Iowa City, Iowa, United States

Melissa L. Swee, MD, MS, FASN

• Jalal, Diana I., VA Iowa City Healthcare System, Iowa City, Iowa, United States

Diana I. Jalal, MD

• Sanders, M. Lee, VA Iowa City Healthcare System, Iowa City, Iowa, United States

M. Lee Sanders, MD, PhD, FASN

• Sarrazin, Mary Vaughan, VA Iowa City Healthcare System, Iowa City, Iowa, United States

Mary Vaughan Sarrazin, PhD

• Thumann, Angie R., VA Iowa City Healthcare System, Iowa City, Iowa, United States

Angie R. Thumann

• Phisitkul, Kantima, VA Iowa City Healthcare System, Iowa City, Iowa, United States

Kantima Phisitkul, MD

• Yamada, Masaaki, VA Iowa City Healthcare System, Iowa City, Iowa, United States

Masaaki Yamada, MD

• Reisinger, Heather, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Heather Reisinger, PhD

• Dixon, Bradley S., VA Iowa City Healthcare System, Iowa City, Iowa, United States

Bradley S. Dixon, MD

Background

Chronic kidney disease (CKD) is common and associated with high rates of morbidity and mortality. Despite evidence that early referral to nephrology improves outcomes, it is estimated that less than half of patients with CKD see a nephrologist. We aimed to improve access to nephrology care by developing a user-friendly Telenephrology dashboard for the 40,000 Veterans receiving care through the Iowa City Veterans Affairs Health Care System.

Methods

The development process adhered to the human-centered design framework, encompassing five phases: (1) Empathize, (2) Define, (3) Ideate, (4) Prototype, and (5) Test. We interviewed patients’ and providers’ regarding perceptions of structural barriers and facilitators for the Telenephrology program, using the Consolidated Framework for Implementation Research (CFIR) as a guide. Data from these interviews were analyzed using directed content analysis. Then, a rapid ideation workshop was convened to generate creative solutions that balance technical requirements with the needs of clinicians and patients.

Results

The iterative design process identified three critical needs: (1) clarity in visualizing data, (2) accuracy of information, and (3) balancing standardization with individualization. The final Telenephrology Dashboard developed through the rapid ideation workshop included: (1) a graph of kidney function over time, (2) tables synthesizing lab data, (3) options to drill down events to specific times, (4) customization of views, and (5) integration of kidney disease progression models. Since the inception of the Telenephrology program in 2018, clinic productivity has increased and wait times have decreased.

Key facilitators identified in interviews included increased access to specialist care and convenience for providers and Veterans. Perceived barriers included: concerns of decreased autonomy and increased workload for primary care providers, added complexity, and lack of sustainability.

Conclusion

Telenephrology increases nephrology access and convenience. Nevertheless, future challenges include concerns around primary care autonomy, workload, and system complexity. Ongoing research is needed to validate the impact of Telenephrology on patient outcomes and physician satisfaction and effectiveness.

Funding

• NIDDK Support