Improving Patient Outcomes in Chronic Kidney Disease in Diabetes via Multiple Educational Formats

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Improving Patient Outcomes in Chronic
KidneyDisease in Diabetes via Multiple
Educational Formats

• A collaboration between the National Kidney
• Foundation and the Diabetes
• Prevention and Control Program (DPCP)
• New York State Department of Health
• Fall, 2006-December, 2007
• Session B5-25664 Dolph Chianchiano

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Rationale

• Rationale
• The National Kidney Foundation (NKF)
• learned that many primary care clinicians
• were not routinely screening for both
• chronic kidney disease (CKD) and diabetes
• co-morbid diseases that adversely impact
• patient outcomes. NKF wanted to increase
• early intervention to improve patient
• outcomes and felt this goal could be
• reached by offering continuing education to
• primary care clinicians.

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Rationale
Cross-sectional analysis of tests at a regional
Lab Corp facility, April1, 2002, through March
31, 2003.
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Rationale

• Random National Sample ofNephrologists, Family
  Physicians, and General Internists

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Objective

• Objective
• In response to the growing prevalence
• of co-morbid CKD and diabetes, the need
• to screen for both these diseases during
• patient encounters, and the recent release
• of NKFs Clinical Practice Guidelines and
• Recommendations for Chronic
• Kidney Disease and Diabetes, educate
• clinicians on timely identification and
• treatment strategies via multiple
• educational formats and delivery
• methodologies.

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Partners

• Partners
• National Kidney Foundations national office and
  New York state affiliates
• New York State Department of Healths Diabetes
  Prevention and Control Program (DPCP)
• New York state Community Diabetes Coalitions

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Process

• Process to Develop and Deliver Programs
• Conduct needs assessment and evaluate data from
  clinicians and NKFs KEEP screening program to
  drive learning objectives and content
• Identify target audience likely to impact
  patients selected primary care physicians,
  nurses, pharmacists, and dietitians, all members
  of a CKD and diabetes care team
• Identify learning objectives with outcomes that
  can change clinical practice

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Select Education Delivery Modes

• Based on Adult Learning Principles, select
  formats for delivering continuing education
• Live symposium using slides and case studies to
  invite dialogue and interaction
• Audio/video teleconferencing delivery to rural
  areas to extend reach and accessibility to
  learning
• Team-teaching by faculty nephrologist and
  primary care or endocrinologist to model desired
  team behaviors in the clinical setting
• Support learning with CKD Pack of printed
  materials for clinicians and patients for use
  after the live program.

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Process (contd)

• Process (cont.)
• Select sites
• Local affiliates collaborate with hospitals that
  support symposia for clinical education
• Recruit workgroup for content development
• Utilized five national experts on CKD, diabetes,
  pharmacy, dietetics, and primary care for
  integrated approach
• Develop content - included
• an easy and cost-efficient protocol for timely
  identification
• pharmacologic guidance for practical
  implementation
• case studies to illustrate timely treatment using
  a team approach.

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Process (cont.)

• Process (cont.)
• Recruit and train faculty
• recruited local faculty considered knowledgeable,
  good teachers and speakers
• each faculty consisted of a nephrologist and
  endocrinologist to model collaboration skills
• Design participant educational packet to extend
  learning
• Patient education resources from NKF inventory
  for the office and to support patient teaching
• Professional education resources on GFR, CKD and
  Diabetes
• Design participant and faculty program manuals
• Printed handout with program agenda and slides

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Process (cont.)

• Process (cont.)
• Create promotion and marketing plan
• Designate symposium as a Grand Rounds to
  signify its importance and encourage attendance
• Sent email blitzes to potential participants,
• Provided posters for hospital sites and local
  marketing materials for affiliates to distribute
• Facilitate continuing education credits
• Provide CME and CE credits for multiple
  disciplines to encourage attendance.
• Evaluate participant and faculty feedback
• Used Scantron evaluation forms for ease of
  processing
• Analyze results for strengths and areas of
  improvement for future programs

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Learning Objectives

• State the public health significance of the CKD
  and diabetes prevalence in New York State, the
  U.S. and around the world
• Describe the use of eGFR (estimated Glomerular
  Filtration Rate) and other methods for timely
  identification of CKD in diabetes
• Discuss the management of CKD in diabetes using
  timely behavioral, nutritional and medical
  interventions to improve patient outcomes

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• Three Key Program Components

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• Easy and cost-efficient protocol for
• timely identification
• of CKD in diabetes
• also referred to as Diabetic Kidney Disease
  (DKD)

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Pharmacologic Guidance
Recommended Dosing and Dosing Adjustments for
Drugs Used to Achieve Glycemic Control in CKD
Stages 3 and 4 NKFs KDOQI Clinical
Practice Guidelines and Clinical Practice
Recommendations for Diabetes and
Chronic Kidney Disease (AJKD,
2007), www.kdoqi.org
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Two Case Study Illustrating Timely Treatment
of CKD in Diabetes Through Medical, Behavioral,
and Nutritional Team Management
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Outcomes

• Outcomes
• Three-hundred and forty clinicians attended
• the symposium statewide
• 98 indicated satisfaction with the program
• 95 said they gained new knowledge
• 85 said they would make changes in their
  practice
• 99 said they would recommend the program to
  their peers.

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Conclusion

• Conclusions
• Educating clinicians about urgent public
• health needs, in multiple educational formats
• and delivery methodologies, are
• effective means for increasing clinician
• awareness and enhancing quality of care
• NKF hopes to take the Grand Rounds
• symposium to additional sites in New York state

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• Questions