Improving Patient Outcomes in Chronic Kidney

Disease in Diabetes via Multiple Educational Formats

A collaboration between the National KidneyFoundation and the Diabetes

Prevention and Control Program (DPCP)New York State Department of Health

Fall, 2006-December, 2007 Session: B5-25664 Dolph Chianchiano

Rationale

Rationale

The National Kidney Foundation (NKF)learned that many primary care clinicianswere not routinely screening for bothchronic kidney disease (CKD) and diabetes;co-morbid diseases that adversely impactpatient outcomes. NKF wanted to increaseearly intervention to improve patientoutcomes and felt this goal could bereached by offering continuing education toprimary care clinicians.

Rationale

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

Rationale

Random National Sample ofNephrologists, Family Physicians, and

General Internists

Objective

ObjectiveIn response to the growing prevalence of co-morbid CKD and diabetes, the needto screen for both these diseases duringpatient encounters, and the recent releaseof NKF’s “Clinical Practice Guidelines andRecommendations for ChronicKidney Disease and Diabetes,” educateclinicians on timely identification andtreatment strategies via multipleeducational formats and deliverymethodologies.

Partners

Partners

• National Kidney Foundation’s national office and New York state affiliates

• New York State Department of Health’s Diabetes Prevention and Control Program (DPCP)

• New York state Community Diabetes Coalitions

Process

Process to Develop and Deliver Programs

• Conduct needs assessment and evaluate data from clinicians and NKF’s 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

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.

Process (cont’d)

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.

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

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

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

Three Key Program Components

Easy and cost-efficient protocol fortimely identification of CKD in diabetes*

*also referred to as Diabetic Kidney Disease (DKD)

Recommended Dosing and Dosing Adjustments for Drugs Used to

Achieve Glycemic Control in CKD Stages 3 and 4*

* NKF’s KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease (AJKD, 2007), www.kdoqi.org

Pharmacologic Guidance

Two Case Study Illustrating Timely Treatment of CKD in Diabetes Through

Medical, Behavioral, and Nutritional Team Management

Outcomes

Outcomes

Three-hundred and forty clinicians attendedthe 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.

Conclusion

Conclusions

Educating clinicians about urgent publichealth needs, in multiple educational formats

and delivery methodologies, areeffective means for increasing clinician

awareness and enhancing quality of care

NKF hopes to take the Grand Roundssymposium to additional sites in New York

state

Questions