Original InvestigationPathogenesis and Treatment of Kidney DiseaseImproving Care Coordination Between Nephrology and Primary Care: A Quality Improvement Initiative Using the Renal Physicians Association Toolkit
Section snippets
Methods
The Mayo Clinic Institutional Review Board determined that this quality improvement study (ID 09-003536) was exempt, and it was approved by the clinical leadership of the practices, whose experience is reported. We investigated nephrology and primary care practices, testing the intervention of providing tools specifically created to improve CKD identification, referral, communication, and comanagement. The experiment included 9 PCP and 5 nephrology practices over 12 to 15 months and concluded
Results
Demographic characteristics of participating practices were derived from site visits and preintervention questionnaires and are presented in Tables 2 and 3. Location was urban or suburban and practices were either group single specialty or solo; numbers of physicians and years in practice varied widely. Nephrologists’ first CKD visit averaged 40 minutes, with 20 minutes for follow-up, and PCPs estimated 35 minutes for first visit, with 20 minutes for follow-up. CKD management styles varied.
Discussion
In this study, the use of specifically tailored tools was associated with enhanced awareness and identification of CKD among PCPs and led to increased communication and improvement in comanagement and cooperation between PCPs and nephrologists.
The PCP practices improved CKD identification, referral to nephrologists, communication, and execution of comanagement plans. Nephrologists improved referral and comanagement processes. Postintervention interviews of PCPs documented increased awareness of
Acknowledgements
This work was presented as an abstract at the American Society of Nephrology’s Annual Meeting in San Diego, CA, October 30 to November 4, 2012.
The authors thank Rebecca J. Schmidt, DO, for critical review of the manuscript.
Support: This study was funded by the Renal Physicians Association from an unrestricted education grant from Abbott Laboratories. Abbott Laboratories had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and
References (46)
- et al.
Cardiovascular outcomes and all-cause mortality: exploring the interaction between CKD and cardiovascular disease
Am J Kidney Dis
(2006) - et al.
Automated clinical reminders for primary care providers in the care of CKD: a small cluster-randomized controlled trial
Am J Kidney Dis
(2011) - et al.
Facilitated process improvement: an approach to the seamless linkage between evidence and practice in CKD
Am J Kidney Dis
(2006) - et al.
Clinical testing patterns and cost implications of variation in the evaluation of CKD among US physicians
Am J Kidney Dis
(2009) - et al.
CKD risk factors reported by primary care physicians: do guidelines make a difference?
Am J Kidney Dis
(2006) - et al.
Identification and referral of patients with progressive CKD: a national study
Am J Kidney Dis
(2006) - et al.
Physician characteristics and knowledge of CKD management
Am J Kidney Dis
(2009) - et al.
The National Kidney Disease Education Program: improving understanding, detection, and management of CKD
Am J Kidney Dis
(2009) Handing out grades for care in chronic kidney disease: nephrologists versus non-nephrologists
Clin J Am Soc Nephrol
(2007)Decision support and CKD: not there yet
Clin J Am Soc Nephrol
(2012)