Intercepting CKD in Primary Care

Presented byElizabeth Montgomery

National Kidney FoundationApril 20, 2015

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

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.

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

OBJECTIVES

• Improve Diagnosis• Improve Quality of Care• Improve Patient Engagement

Double the number of people with CKD that know that they have CKD by 2020.

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.

…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

PCP-in-a-Box is now…

A Primary Care Initiative

Early Detection and Prevention

10

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

THANK YOU

Elizabeth Montgomery

Elizabeth.Montgomery@kidney

.org

212.889.2210 x 196