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Kidney Week

Abstract: PO0531

Healthcare Engineering to Predict Time and Resource Impact of Integrating a CKD Education Intervention into Primary Care Practice

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Wright Nunes, Julie A., University of Michigan, Ann Arbor, Michigan, United States
  • Ellies, Tammy, University of Michigan, Ann Arbor, Michigan, United States
  • Chen, Emily P., University of Michigan, Ann Arbor, Michigan, United States
  • Fan, Audrey, University of Michigan, Ann Arbor, Michigan, United States
  • Rockwell, Pamela G., University of Michigan, Ann Arbor, Michigan, United States
  • Fagerlin, Angela, University of Utah Health, Salt Lake City, Utah, United States
  • Garcia-Guzman, Luis M., University of Michigan, Ann Arbor, Michigan, United States

This study describes the novel use and application of healthcare engineering and Discrete Event Simulation (DES) to study the impact of adding a physician-led chronic kidney disease (CKD) education review for patients in two primary care settings.


We developed a computer model to simulate a General Internal Medicine and Family Medicine practice and used it to examine the impact of adding a physician-led CKD education review into routine primary care appointments. To create the computer models we gathered data using real-time process mapping and information from the electronic health record (EHR). The physician-led education review included physicians reviewing a one-page education information sheet, tailored to individual patients. Computer models of each clinic were developed to test the effect on patient flow and time through clinic appointments using different proportions of patients with CKD for which a physician would review the CKD education. We also tested varying amounts of time it would take for physicians to review CKD education within the model.


Adding the physician-led review of CKD education into clinic visits did not significantly increase patient flow or time through clinic. Incrementally increasing potential times for the CKD education review, up to 10 minutes with 50% of all patients, did not reduce patient flow or significantly increase overall time of patients going through clinic from check-in to check-out. For General Internal Medicine, the 95% baseline Confidence Interval for patient time through clinic was between 53.4 min and 65.03 min whereas the 95% Confidence Interval when CKD education was reviewed with 50% of patients resulted in an estimated visit time between 57.54 min and 69.17 min. The estimated resource utilization of physicians increased by about 5%. Similar results were found for Family Medicine.


This research allowed us to perform a “what-if” analysis on the effect of introducing physician-led CKD patient education into routine primary care practice. Results show that it is possible to introduce patient education and support without major disruptions in clinic flow nor patient time through clinic.


  • NIDDK Support