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Abstract: TH-PO1086

Tele-Nephrology to Provide Efficient and Patient-Centered Ambulatory Care

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
  • Piero, Nicole, VA Medical Center, Milford, Ohio, United States
  • Goodall, Cristy A., Cincinnati VA Medical Center, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
Background

Subspecialty referrals in ambulatory care in the U.S. have doubled in the last decade. According to an AAMC-commissioned study in 2017, there will be a projected a shortage of up 61,800 nonprimary care specialists by 2030. We evaluated whether the incorporation of tele-nephrology within ambulatory care could improve efficiency and patient-centeredness.

Methods

In a large Veteran’s Affairs health system, we assessed outpatient utilization of tele-nephrology via e-Consults (e-C), defined as either electronic, telephonic or video communication with the referring provider and/or the patient. We implemented a pilot to pro-actively triage eligible renal consults in patients 75 or older (Grp I) to be initially addressed via e-Consults compared to those < 75 (Grp II). e-C assessments and ability to completely address the consult without need for in-person (IP) visit were compared by Chi-square or Fishers tests.

Results

In FY 2016-17, of the 1,803 consults, inital e-C assessments were peroformed on 172 (9.5%), leaving 1,631 IP visits. Since the pilot, between 1/1/18 and 5/29/18, 249 renal consults were received of which, 9% (22/249) patients were Grp I. 86% (19/22) in Grp I underwent initial e-C assessments compared to 14% (33/227) in Grp II (p < 0.001). Of the initial e-C assessments 26% (5/19) in the Grp I were completed by avoiding IP visit; whereas 42% (14/33) in Grp II were completed without IP visit (p = 0.37). Pilot Grp I was 100% male (mean age of 81.3; mean serum creatinine 1.84 mg/dl); 78% were diabetic and 78% hypertensive. They resided between 2 and 42 miles from the clinic, and 20% were receiving home-based primary/hospital care. The mean time to complete an e-C assessment was 1.43 days from date of referral, as compared to > 30 day wait for IP visit. Along with comprehensive medical review, 93% received renal-specific diagnostic assessments (lab tests, radiology tests, medication review management). Overall, initial e-C (52/249) created 21% efficiency; and created 8% capacity (19/249) by avoiding the need for IP visits, with same resources.

Conclusion

e-Consults reduced time to initial renal assessment, allowed prompt diagnostic testing, medication management, and avoided travel burden for patients and relatives. Tele-nephrology models of ambulatory care delivery can improve efficiency, enhance patient-safety, and reduce real and opportunity costs.

Funding

  • Clinical Revenue Support