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Kidney Week

ASN / Education & Meetings / Kidney Week /
Abstract: SA-PO1112

Need and Efficacy of Add-On Opt-Out Strategy to Promote Delivery of Kidney Replacement Therapy (KRT)-Directed Comprehensive Pre-ESKD Education (CoPE) for All Patients with Advanced CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Shell, Popy, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Joyce, Malea, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Scheiffele, Grant D., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Subhash, Shobha, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Lyles, Teresa A., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Jia, Huanguang, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
Background

CoPE is a must for informed KRT selection and use; however, only a minority of advanced CKD patients receive CoPE before KRT. We lack evidence-based estimations for patients’ interest for CoPE and effective strategies to facilitate CoPE for all patients with advanced CKD. Mail-inviting eligible patients derived from an electronic health record database can improve advanced CKD identification and aid CoPE dissemination; however, its efficacy has not been tested.

Methods

We conducted secondary analysis of recruitment processes for the ongoing TEACH-VET study aimed to evaluate the benefits of CoPE (vs. usual care) on many patient-level outcomes among Veterans with advanced CKD. TEACH-VET employs a mail-based opt-out strategy; all advanced, stage 4 and 5 CKD patients are extracted from the clinical database, and mail-invited to receive CoPE or usual care (opt-in cohort). Patients not self-responding to study invite within two-week period are actively contacted (opt-out cohort). We examined the rates and efficiency of CoPE interest assessed by enrollment as co-primary outcomes, and successful contact with patients and final randomization as secondary outcomes.

Results

Of the 1130 patients eligible for the opt-in cohort, 90 (8%) enrolled for education with passive, strategy. Significantly higher fraction (n=293, 48%, p<0.001) of the eligible 617 approached through active outreach were enrolled for education. Overall, 77% of all CoPE enrollments required an active outreach. Both, upstream successful contacts (72% vs. 10%, p<0.001) and the downstream randomizations into study (34% vs. 7%, p=0.01) were higher for active outreach group. Subgroup analysis of those successfully contacted with either method showed that enrollments were higher among passive approach (80%), compared to active outreach (66%, p=.02) group. The efficiency of add-on active outreach was significantly better, with time per successful approach 29±8 vs. 169±183 mins, p<.001, per successful enrollment 25.33±11.57 vs. 140.11±157, p<0.001, and randomization 92±34 vs. 319±385, p<0.001, compared to passive strategy.

Conclusion

Adopting a process of active outreach allows higher and more efficient enrollments for the provision of CoPE, necessary for informed KRT decision-making.

Funding

  • Veterans Affairs Support