Abstract: SA-PO1130
The National Kidney Foundation's CKD Learning Collaborative: Transforming Care across University Health in Kansas City, Missouri
Session Information
- CKD: Patient-Oriented Care and Case Reports
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Shah, Jignesh, University of Missouri-Kansas City, Kansas City, Missouri, United States
- Bhattacharya, Rajib, University of Missouri-Kansas City, Kansas City, Missouri, United States
- Schultz, Megan, National Kidney Foundation Inc, New York, New York, United States
Background
National Kidney Foundation (NKF) implemented a CKD intercept project in collaboration with University Health(UH) to improve CKD diagnosis and recognition and clinician confidence and engagement in CKD management. This is done to implement a chronic disease self-management program (CDSMP) tailored for people living with CKD, using primary care outreach as the referral mechanism to Nephrology, and introduce a CKD learning collaborative model to provide integrated care delivery.
Methods
We assessed current CKD testing and diagnosis levels in select clinics at UH. We reviewed existing workflows for diabetes, hypertension, and wellness and worked with the technical team to include EHR data for risk stratification of the initial patient cohort. We determined the individual practices of participating clinicians, provided clinician decision support and workflow-related tools, then utilized them in partnership with clinicians and measured their confidence and engagement throughout interventions.
Results
We improved the identification of proteinuria and eGFR calculation of the at-risk patient population by 62.8%. Identification of patients with eGFR lower than 60, screened, identified, and staged appropriately improved by 60%. ARB and Statin use increased by, 89.9% and 28.5 %, respectively, across all CKD stages. We did not see significant improvements in SGLT2i, GLP-1 agonist, and MRA prescription patterns.
Conclusion
NKF and University Health (UH) partnered to introduce the CKD intercept project in select clinics. The comprehensive interventions covered various aspects of CKD management, improved CKD recognition in primary care, tested eGFR and Urine Albumin Creatinine Ratio, and referral patterns. Clinician confidence and engagement improved regarding CKD identification, self-management, NSAID avoidance ACEI/ARB, and SGLT2i use. We suggest community-level efforts to enhance CKD testing and management.
CKD collaborative model