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To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

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Kidney Week

Abstract: TH-PO543

Applying Lean Tools to Optimize Delivery of Patient CKD Education in Primary Care

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention


  • Wright Nunes, Julie A., University of Michigan Health System, Ann Arbor, Michigan, United States
  • Chen, Emily P, University of Michgan, Ann Arbor, Michigan, United States
  • Kerr, Eve, University of Michigan, Ann Arbor, Michigan, United States
  • Fan, Audrey, Univ of Mich, Northville, Michigan, United States
  • Nakai, Tejpreet, Univeristy of Michigan, Ann Arbor, Michigan, United States
  • Garg, Gunjan, University of Michigan, Ann Arbor, Michigan, United States
  • Fagerlin, Angela, University of Utah, Salt Lake City, Utah, United States

Eighty percent of patients with CKD do not have the knowledge necessary to be fully activated in CKD management. Efficient and sustainable programs are needed to address patient education needs early in the CKD care continuum.


Applying Lean Tools (cause/effect analysis, process mapping / re-engineering), we created an efficient and sustainable way to integrate CKD patient education seamlessly into primary care practice. Utilizing a multi-disciplinary team (including primary care and nephrology physicians, patients, medical assistants, nursing, check-out staff, Health IT, and Lean coaches) a current-state process map of patient care and education was created for a large primary care practice. Lean coaches facilitated the multi-disciplinary team to create an improved future-state process that incorporated a CKD education module (a patient education worksheet) into current practice, using existing staff and resources. Content of the worksheet was optimized using quality improvement techniques. Health IT staff created an electronic version to use in the electronic medical record (EMR). This electronic patient education worksheet auto-populates with each patient’s eGFR, blood pressure, and urine protein values. Medical assistants enter the worksheet into the EMR for patients with CKD stages 3-5 during patient check-in for routine visits. Providers review this worksheet in the EMR with patients during clinic encounters. Providers may enter 1-2 tailored messages about shared care goals. The worksheet prints automatically upon check-out and is given to the patient.


Pilot testing shows the process is efficient and feasible to integrate into busy clinical settings. It takes seconds (two key-strokes) to enter into the EMR and approximately ~2 minutes for providers to review. Next steps will examine the impact of the electronic education worksheet and future state process on patient, clinic and provider related outcomes.


We provide a model of a future state process that incorporates patient CKD education seamlessly into practice, leveraging IT resources and existing clinic staff. The ultimate aim of this project is to improve patient CKD knowledge by addressing the unmet need of providing disease-specific education to patients early in the care continuum.


  • NIDDK Support