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Kidney Week

Abstract: FR-PO343

Using Lean-Six Sigma Principles to Develop a Telenephrology Dashboard to Monitor Rural Veterans at Risk of Kidney Disease Progression

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Swee, Melissa L., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Sanders, M. Lee, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Phisitkul, Kantima, Iowa City Veteran's Health Administration, Iowa City, Iowa, United States
  • Thumann, Angie R., Iowa City Veteran's Health Administration, Iowa City, Iowa, United States
  • Neuzil, Nikki L., Iowa City Veteran's Health Administration, Iowa City, Iowa, United States
  • Dixon, Bradley S., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background

Chronic kidney disease (CKD) affects about 14% of Americans, with a 34% greater prevalence in Veterans than the general population. Although early identification and consultation improves outcomes and lowers costs, access is challenging for rural Veterans. To improve access, we developed a telenephrology dashboard to monitor Veterans with CKD and intervene accordingly.

Methods

Lean Six-Sigma principles and the DMAIC (Define-Measure-Analyze-Improve-Control) framework were employed in this quality improvement project. During the “Define” phase, a project charter was drafted defining the scope and key stakeholders. This informed the “Measure” and “Analyze” phases, where the voice of the customer, current and future state maps, and process observation were utilized. In the “Improve” phase, PDSA (Plan-Do-Study-Act) cycles refined dashboard design. The “Control” phase is ongoing.

Results

A telenephrology dashboard was created to monitor patients with kidney disease within the Iowa City VA Health Care System.

Voice of the customer (primary care providers and case managers) revealed 3 objectives: (1) timely identification of CKD risk and progression, (2) rapid access to specialty care, and (3) improvement of patient satisfaction.

Process observation and mapping revealed opportunities for early identification and intervention for CKD using telenephrology protocols (Figure).

From April 2018 to March 2019, 1080 charts were flagged and reviewed by the telenephrology case manager. Among these, e-consultations by nephrologists were performed for 364 Veterans (33.7%).

Conclusion

A telenephrology dashboard was created to monitor Veterans with CKD within the Iowa City VA Health Care system. This enables real-time access to nephrologists, thereby reducing wait-times to the next appointment and allowing for active surveillance of renal problems, and may improve overall quality of care.

Funding

  • Veterans Affairs Support