Abstract: TH-PO524

Improving Implementation of Evidence-Based CKD Care for an Underserved Population: An IT-Enhanced Collaborative Care Model

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Vazquez, Miguel A., University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Velazquez, Javier A, Pieces Technologies, Dallas, Texas, United States
  • Roy, Vibin, PCCI, Dallas, Texas, United States
  • Li, Xilong, University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Toto, Robert D., University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Oliver, George, Parkland Health and Hospital System, Dallas, Texas, United States
  • Jaiyeola, Adeola O., Parkland Health & Hospital System, Dallas, Texas, United States
  • Adams-Huet, Beverley, University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Budhwar, Nitin, University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Barker, Blake R., University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Moran, Brett, Parkland Health & Hospital System, Dallas, Texas, United States
  • Santini, Noel O., UT Southwestern/PHHS, Dallas, Texas, United States
  • Ma, Ying, Parkland Center for Clinical Innovation, Dallas, Texas, United States
Background

There is a gap between knowledge and implementation of evidence-based guidelines (EBG) for treating CKD. Developed at Parkland Health System (PHHS), a safety net hospital serving a predominantly minority population in Dallas County, PIECES is a novel health information technology (IT) that can be embedded in the electronic health record to detect patients with conditions of interest and monitor outcomes. We hypothesized that using PIECES in a collaborative model of primary and nephrology care for patients newly diagnosed with CKD or referred to a CKD clinic at PHHS would improve implementation of EBG.

Methods

PIECES was used to identify patients with previously undiagnosed CKD or newly referred to a CKD kidney clinic and to monitor clinical measures and improve adherence to EBG for CKD care. The main study outcomes were blood pressure (BP) control, use of renin-angiotensin-aldosterone system blockers (RAAS-ACE inhibitors or ARBs) and statins for patients receiving care enhanced by PIECES (implementation group) compared to control patients receiving usual care.

Results

Demographics and baseline (BL) characteristics were similar for patients in implementation (n=92) and control (n=127) groups. After a follow-up (FU) of 6-24 months the use of RAAS (88% vs 59.2%, p<0.0001) and statins (79.4 vs 51%, p<0.0001) was significantly higher in the implementation than in the control group (Figure). In the implementation group, BP of <140/90 at BL and FU was achieved by 50% and 59% (p=0.2) and BP of <130/80 was met by 22% and 28% (p=0.2) respectively; the BP responses were not statistically different from controls.

Conclusion

In this study of collaborative care in primary and nephrology practices use of an IT-embedded program improved implementation of CKD EBGs including use of RAAS and statins. This model can lead to better care, and has the potential to improve outcomes, in underserved populations with CKD.

Funding

  • NIDDK Support