intercepting ckd in primary care presented by elizabeth montgomery national kidney foundation april...
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Intercepting CKD in Primary Care
Presented byElizabeth Montgomery
National Kidney FoundationApril 20, 2015
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1984• Widely regarded as a public
health threat.• Widely recognized for its
impact on mortality and health care costs.
• Included in routine preventative screening in primary care.
• Diagnostic delays are not tolerated by the public or the system.
2014
• Not openly discussed or commented on.
• A diagnosis that inferred little to be done and very little hope.
• Low primary care awareness, knowledge or engagement
Bre
ast C
ance
r
CultureChange
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3
10%• Percentage of people with CKD that today
know that they have CKD.
• The majority have advanced CKD, are on dialysis or awaiting transplant.
90%• Who cannot know they have CKD until a medical
professional tells them.
• Are unaware that advancing CKD places them at significantly greater risk for heart attack, stroke or death.
• Have no opportunity to be proactive, make informed choices or protect their kidney health.
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Diagnostic Delay: not exclusively a knowledge gap
≥50% <50% 0%
Clinician likelihood of identifying patient with CKD(n=445 PCPs)
19 (4.3%) 217 (48.8%) 209 (47.0%)
Clinician awareness: CKD screening in T2DM
100% 98.2% 97.6%
Clinician awareness:<60 eGFR indicates CKD
73.7% 59.9% 57.4%
Clinician awareness:>30 ACR in urine indicates CKD
57.9% 53.0% 54.5%
Szczech LA, et al. PLoS One 9(11);
2014:e110535
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OBJECTIVES
• Improve Diagnosis• Improve Quality of Care• Improve Patient Engagement
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Double the number of people with CKD that know that they have CKD by 2020.
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VISION:Create a culture in primary care where:• preservation and protection of kidney health is a public health priority. • testing and diagnosis of CKD is routine standard of care for at-risk
populations. • clinicians routinely engage their patients in conversations about the
importance of kidney health and actively support patient alignment with behaviors that will protect it.
Double the number of people with CKD that know they have CKD by 2020.
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…a major public health initiative leveraging demonstrated best practices in large scale change in health care.
Consumers/Patients
• Patient Journey• Research• Laboratory Interventions• Improve engagement channels• Tools to improve communication
Medical Societies/ Healthcare Providers
• Laboratory Profiling• New approaches to CME• Quality Improvement &
Maintenance of Certification CME
• Research• New tools• Process changes (CPT Codes)
Academia
• Med School Training• Residency
curriculum• Research
Hospitals & Health Networks
• Improved communication• Quality Improvement
activities• Developing performance
measures• Process changes (CPT codes)
Insurers(Payers and Malpractice)
• Performance Measures
• Pay for performance• Population Health
Interventions• Disease Management/
Wellness Programs
Industry(Laboratory, Diagnostic, & EMR)
• Medical Home• Laboratory Innovations• Novel approaches to
testing
Government
• Pay for Performance• Performance measures
• Research• Population Health Interventions
IMPROVEDAWARENESS
Patient Clinician
Diagnosis
XSystem
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PCP-in-a-Box is now…
A Primary Care Initiative
Early Detection and Prevention
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DemonstratedApplication of CKD Guidelines
Limited ApplicationOf CKDGuidelines
ClinicianUnaware of Practice Gaps
ClinicianAware of Practice Gaps
Clinicians with known/perceived gaps
Lack the calibration between knowing and doing to recognize need for improvement
“ConscientiousClinicians”
Innovative Strategies are necessary
CKDinform Audience
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THANK YOU
Elizabeth Montgomery
Elizabeth.Montgomery@kidney
.org
212.889.2210 x 196