Improving Care Coordination Between Nephrology and Primary Care: A Quality Improvement Initiative Using the Renal Physicians Association Toolkit

Haley, William E.; Beckrich, Amy; Sayre, Judith J.; McNeil, Rebecca B.; Fumo, Peter; Rao, Vijaykumar M.; Lerma, Edgar V.

doi:10.1053/j.ajkd.2014.06.031

Cited by 52 publications

(82 citation statements)

References 40 publications

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“…Several studies provide insights into the benefits of receiving care from both specialists and PCP among diabetes patients with chronic kidney disease [11,12], tuberculosis [13] and cancer [14–18]; however, little is known about patients dually-diagnosed with diabetes and compensated cirrhosis [19]. In addition, access to care may also influence on how these complex patients visited different physician specialty.…”

Section: Introductionmentioning

confidence: 99%

Who Treats Patients with Diabetes and Compensated Cirrhosis

et al. 2016

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BackgroundIncreasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis.ObjectiveWe examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis.DesignRetrospective cross-sectional study using 2000–2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases.PatientsWe identified 22,516 adults (≥ 18 years) dually-diagnosed with diabetes and compensated cirrhosis. Patients with decompensated cirrhosis, HIV/AIDS, or liver transplantation prior to dual diagnosis were excluded.Main MeasuresPhysician mix categories: patients were assigned to one of four physician mix categories: primary care physicians (PCP) with no gastroenterologists (GI) or endocrinologists (ENDO); GI/ENDO with no PCP; PCP and GI/ENDO; and neither PCP nor GI/ENDO. Health care utilization: annual physician visits and health care expenditures were assessed by four physician mix categories.Key ResultsThroughout the 14 years of study, 92% of patients visited PCPs (54% with GI/ENDO and 39% with no GI/ENDO). The percentage who visited PCPs without GI/ENDO decreased 22% (from 63% to 49%), while patients who also visited GI/ENDO increased 71% (from 25% to 42%).ConclusionsThis is the first large nationally representative study to document the types of physicians seen by patients dually-diagnosed with diabetes and cirrhosis. A large proportion of these complex patients only visited PCPs, but there was a trend toward greater specialty care. The trend toward co-management by both PCPs and GI/ENDOs suggests that PCMH initiatives will be important for these complex patients. Documenting patterns of primary and specialty care is the first step toward improved care coordination.

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Section: Introductionmentioning

confidence: 99%

Who Treats Patients with Diabetes and Compensated Cirrhosis

et al. 2016

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“…For example, achieving improvements in CKD outcomes such as blood pressure control likely requires an additional focus on improving care coordination between primary care physicians and nephrologists and encouraging patient activation. 21 Further comparison studies are needed to evaluate multifaceted interventions designed to combine CDS tools with these additional components to effectively improve CKD management in primary care.…”

Section: Resultsmentioning

confidence: 99%

Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD)

2016

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Background: Early detection of chronic kidney disease (CKD) can lead to interventions to prevent renal failure and reduce risk for cardiovascular disease, yet adherence to treatment goals is suboptimal in the primary care setting. The purpose of this study was to assess whether clinical decision support (CDS) can be used to improve the identification and management of CKD.Methods: This 2 year demonstration study was conducted in 11 primary care PPRNet practices. CDS included a risk assessment tool, health maintenance protocols, flow chart and a patient registry. Practices received performance reports and hosted annual half day on-site visits.Results: There were statistically significant increases in screening for albuminuria (median 24 month change 30%, p < 0.0005) and monitoring albuminuria (median 24 month change 25%, p < 0.0005). An absolute 23.5% improvement in appropriate use of ACE-inhibitor or angiotensin receptor blocker and an absolute 7.0% improvement in hemoglobin measurement were not statistically significant. There were no clinical or statistically significant differences in other CKD CQMs. Facilitators to CDS use included practices' prioritization of improving CKD and staff use of standing orders. Barriers included incorporating use into existing workflow and variable use among providers.Conclusions: Use of CDS to improve CKD identification and management in primary care practices shows promise. However, other barriers must be addressed to effectively achieve improvements in CKD outcomes. (J Am Board Fam Med 2016;29:604 -612.)

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“…The Renal Physician Association performed a longitudinal quality improvement study of a tool-based intervention in several nephrology practices and their referring PCP practices [47]. Implementation of specially tailored audits that focused on CKD identification, communication, and patient education were highly effective in augmenting awareness and identification of CKD among PCPs, as well as increasing communication between clinical practices, and better co-management and cooperation between the PCP and the nephrologist [47].…”

Section: Current Approaches To Alleviate Health Disparities For Ckd Imentioning

confidence: 99%

“…Implementation of specially tailored audits that focused on CKD identification, communication, and patient education were highly effective in augmenting awareness and identification of CKD among PCPs, as well as increasing communication between clinical practices, and better co-management and cooperation between the PCP and the nephrologist [47]. In addition, continuous quality improvement, evaluation, and review cycles, such as the Plan-Do-Study-Act cycles proposed by the Agency for Healthcare Research and Quality should be an intrinsic part of this, or any collaborative effort in the care of chronic diseases [48].…”

Section: Current Approaches To Alleviate Health Disparities For Ckd Imentioning

confidence: 99%

Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

Harding¹,

Mersha

Vassalotti

et al. 2017

Am J Nephrol

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Background: African Americans (AAs) suffer the widest gaps in chronic kidney disease (CKD) outcomes compared to Caucasian Americans (CAs) and this is because of the disparities that exist in both health and healthcare. In fact, the prevalence of CKD is 3.5 times higher in AAs compared to CAs. The disparities exist at all stages of CKD. Importantly, AAs are 10 times more likely to develop hypertension-related kidney failure and 3 times more likely to progress to kidney failure compared to CAs. Summary: Several factors contribute to these disparities including genetic and social determinants, late referrals, poor care coordination, medication adherence, and low recruitment in clinical trials. Key Messages: The development and implementation of CKD-related evidence-based approaches, such as clinical and social determinant assessment tools for medical interventions, more widespread outreach programs, strategies to improve medication adherence, safe and effective pharmacological treatments to control or eliminate CKD, as well as the use of health information technology, and patient-engagement programs for improved CKD outcomes may help to positively impact these disparities among AAs

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Improving Care Coordination Between Nephrology and Primary Care: A Quality Improvement Initiative Using the Renal Physicians Association Toolkit

Cited by 52 publications

References 40 publications

Who Treats Patients with Diabetes and Compensated Cirrhosis

Who Treats Patients with Diabetes and Compensated Cirrhosis

Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD)

Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

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