Improving Primary Care Treatment of CKD - PowerPoint PPT Presentation

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Improving Primary Care Treatment of CKD

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Improving Primary Care Treatment of CKD David Feldstein, MD Assistant Professor Department of Medicine UW SMPH Overview Background Needs Assessment CKD Management ... – PowerPoint PPT presentation

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Title: Improving Primary Care Treatment of CKD


1
Improving Primary Care Treatment of CKD
  • David Feldstein, MD
  • Assistant Professor
  • Department of Medicine
  • UW SMPH

2
Overview
  • Background
  • Needs Assessment
  • CKD Management Tool
  • Implementation
  • Questions

3
Chronic Kidney Disease
  • Over 26 million cases in US and growing
  • Prevalence 6.6 in adults in WI
  • Consumes 6.5 of Medicare Budget
  • Progression to ESRD can be prevented
  • Patients currently not receiving care based on
    guidelines

Coresh J, Selvin E, Stevens LA, et al. JAMA.
2007298(17)2038-2047. Shankar A, Klein R, Klein
BE. Am J Epidemiol. 2006164(3)263-271. U.S.
Renal Data System. USRDS 2007 Annual Data Report.
MD 2007. KDOQI Clinical Practice Guidelines for
Chronic Kidney Disease Evaluation,
Classification, and Stratification
http//www.kidney.org/professionals/KDOQI/guidelin
es_ckd/toc.htm.
4
Chronic Kidney Disease
  • Stages
  • Kidney damage with normal GFR (gt90 mL/min1.73
    m2)
  • Kidney damage with mild decrease GFR (60-89)
  • Moderate decrease GFR (30-59)
  • Severe decrease GFR (15-29)
  • Kidney Failure GFR lt15 or dialysis

5
Chronic Kidney Disease
  • Stages
  • Kidney damage with normal GFR (gt90 mL/min1.73
    m2)
  • Kidney damage with mild decrease GFR (60-89)
  • Moderate decrease GFR (30-59)
  • Severe decrease GFR (15-29)
  • Kidney Failure GFR lt15 or dialysis

6
Project
  • Goal
  • Develop electronic tool to help PCCs care for
    their patients with CKD
  • Phases
  • Needs assessment
  • Development of CKD management tool
  • Implementation of CKD management tool

7
Needs Assessment
  • 9 Phone interviews
  • 5 Focus Groups
  • 26 PCCs
  • Questions
  • Barriers and Facilitators to following CKD
    guidelines
  • Barriers and Facilitators to CKD care
  • Ideal CKD Management Resources
  • Collaboration with subspecialists
  • Thematic analysis

8
CKD Management Barriers
  • Clinician factors
  • External
  • Multiple demands on time
  • Internal
  • Lack of knowledge
  • Patient factors
  • Travel
  • Non-adherence to treatment regimen
  • Systems issues
  • Access to information
  • Lack of decision support systems

9
CKD Management Tool
  • Based on patient centered medical home
  • Components
  • CKD guideline checklist
  • Based on NKFs KDOQI guidelines
  • Individualized to patient
  • Point of care educational modules
  • Integrated into guideline checklist
  • Electronic nephrology consultation
  • Patient information resources
  • Human factors input for usability

10
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14
Usability Testing
  • If you build it will they come?
  • Determine functions to test
  • Develop scenarios
  • Develop testing scripts
  • 3 user types
  • Evaluate plan
  • Think aloud interviews thematic analysis
  • Questionnaires

15
Usability Testing Clip
16
Implementation
  • 20 PCCs and their clinic support staff
  • 6 month trial using tool with stage 3 CKD
    patients
  • Proof of concept
  • Outcomes
  • Changes in PCCs knowledge and self-efficacy
  • Guideline usage
  • Tool usage

17
Acknowledgements
  • Funding
  • UW ICTR Type 2 Translational Pilot Grant
  • UW Department of Medicine RD Grant
  • Salary support ICTR Science Award 1KL2RR025012
  • WREN
  • Paul Smith, MD Mike Grasmick, PhD Katie
    Pronschinske
  • WiNHR
  • Howard Bailey, MD Laila Borokhim
  • Industrial Engineering
  • Doug Wiegmann, PhD Ashley Eggerman Renaldo
    Blocker

18
KDOQI
  • National Kidney Foundation Kidney Disease
    Outcomes Quality Initiative
  • Evidence-based clinical practice guidelines for
    all stages of CKD
  • Since 1997 developed 13 guidelines

19
Focus Group Characteristics
Years in practice (M, SD, Range) 13.8 (8.9) (1-31)
Gender (Male, ) 13 (50)
Specialty FM (, ) 18 (69)
Practice location (, ) R 6 (24) S 7 (28) U 12 (48)
20
CKD Management Barriers
  • Patient factors
  • Multiple physicians
  • Travel
  • Insurance Issues
  • Not adherent to treatment regimen
  • Lack of understanding of CKD

21
CKD Management Barriers
  • Systems issues
  • Access to information
  • Cant access information across systems
  • No access to nephrologists
  • Lack of decision support systems
  • Not set up for CKD care
  • Based on acute care model
  • Unable to monitor f/u
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