Kidney Week

Abstract: SA-PO1076

Advancing Nephrology Care Access for Veterans: Implementation and Insights from a Telenephrology Program

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 3
  October 26, 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., Iowa City VA Medical Center, Iowa City, Iowa, United States

Melissa L. Swee, MD, MS, FASN

• Sarrazin, Mary Vaughan, Iowa City VA Medical Center, Iowa City, Iowa, United States

Mary Vaughan Sarrazin, PhD

• Sanders, M. Lee, Iowa City VA Medical Center, Iowa City, Iowa, United States

M. Lee Sanders, MD, PhD, FASN

• Reisinger, Heather, University of Iowa Health Care, Iowa City, Iowa, United States

Heather Reisinger, PhD

• Phisitkul, Kantima, Iowa City VA Medical Center, Iowa City, Iowa, United States

Kantima Phisitkul, MD

• Thumann, Angie R., Iowa City VA Medical Center, Iowa City, Iowa, United States

Angie R. Thumann

• Dixon, Bradley S., Iowa City VA Medical Center, Iowa City, Iowa, United States

Bradley S. Dixon, MD

• Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States

Diana I. Jalal, MD

Background

Chronic kidney disease (CKD) is a significant health concern among Veterans, often compounded by delayed nephrology referrals. A Telenephrology program was introduced at the Iowa City Veterans Affairs Health Care System (ICVA) in 2018. A dashboard alerted the nephrology service when CKD or acute kidney injury were noted prompting either an e-consult or an outpatient consult to the nephrology service. Here, we evaluated the impact of the program on nephrology encounters.

Methods

We conducted a retrospective cohort study involving Veterans receiving care in Veterans Integrated Service Network (VISN) 23, which consists of 8 medical centers and affiliated clinics. The cohort included patients with at least one eGFR <60 during from 2014 to 2016. Patients with nephrology encounters before 2014 or who died before 2016 were excluded. Annual outpatient virtual and face to face nephrology encounters from 2016 to 2020 were identified. Poisson regression was used to compare nephrology encounters per months alive before and after the intervention to other VISN 23 sites during the same time period, controlling for patient characteristics.

Results

We identified 5161 eligible patients in Iowa City and 44618 in other VISN 23 sites. Veterans in ICVA were older with higher rates of heart failure, peripheral vascular disease, and hypertension. Nephrology encounters rose by ~78% and 114% during 2018-2019 and 2019-2020 compared to the average annual encounters during 2016-2018 [Rate ratios were 1.78 (95% CI, 1.62-1.95; p<.001) and 2.14 (95% CI, 1.97-2.32; p<.001)]. Compared to other sites in VISN23, nephrology encounters per month increased to a lesser extent in ICVA. In the period March 2018-February 2019, the increase in encounters in ICVA was 86% of that observed in other VISN 23 sites (relative rate = 0.86; 95% CI, 0.79-0.95; p<.001). During 2019-2020, the rate of increase in Iowa City was 85% of the increase observed in other VISN 23 sites (relative rate = 0.85; 95% CI, 0.78-0.93; p<.001).

Conclusion

The Telenephrology program in Iowa City improved access to nephrology care but the annual increase in virtual and face-to-face encounters was smaller than seen in other VISN23 facilities. Future studies will explore the impact of the Telenephrology program on clinical outcomes.

Funding

• NIDDK Support