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Kidney Week

Abstract: SA-PO030

Implementing a Successful Tele-Nephrology Program for Rural Veterans

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Bonegio, Ramon, Veterans Health Administration, Boston, Massachusetts, United States
  • Tuozzo, Katharine, Veterans Health Administration, Boston, Massachusetts, United States
  • Rifkin, Ian R., Veterans Health Administration, Boston, Massachusetts, United States
  • Kroll-Desrosiers, Aimee, Veterans Health Administration, Boston, Massachusetts, United States
  • Crowley, Susan T., Veterans Health Administration, Boston, Massachusetts, United States
  • Mattocks, Kristin, Veterans Health Administration, Boston, Massachusetts, United States
  • Moore, David Thomas, Veterans Health Administration, Boston, Massachusetts, United States

Group or Team Name

  • On Behalf of the Telenephrology Enterprise Wide Initiative.
Background

Rural Veterans experience increased morbidity and mortality as a result of chronic kidney disease (CKD) and refractory hypertension. Nephrologists usually practice in urban, acute-care facilities and decreased access to specialist care likely contributes to poorer outcomes in rural Vaterans.

Methods

We established a Tele-Nephrology Hub & Spoke Network (TNN) to provide care to rural facilities. Hub nephrologists reviewed the medical record and provided video-based visits to spoke sites in Maine, New Hampshire, Indianapolis, Oklahoma, Montana, and Colorado. Where possible, hub staff trained a local advanced practice provider (APP) to triage consults and manage emergencies.

To understand barriers and facilitators to TNN implementation, we conducted semi-structured interviews with clinicians at five spoke sites. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to develop our interview guide. Interviews were conducted using Microsoft Teams and qualitative data was analyzed using open thematic analysis. Results are presented according to each major RE-AIM dimension.

Results

Reach: Rural and highly rural Veterans were seen at all spoke sites. Veterans were given the option of seeing a local and/or tele-provider. Adoption: Adoption was more successful when facilities had a local APP. Local APPs were quickly able to triage consults and address emergencies independently. Where APP were not available, more reliance was placed on hub providers. Implementation: The TNN was successfully implemented at each facility, with >50% of consults being addressed through telenephrology. Maintenance: A telenephrology champion organized the program. Across nearly every interview, the telenephrology champion was mentioned as a critical reason for program success.

We anticipated finding that sites had challenges with technology or that Veterans were uncomfortable with remote care but neither of these issues emerged during interviews. We found that the Covid-19 pandemic served as an excellent introduction to telehealth and so there was little anxiety about receiving care from remote nephrologists.

Conclusion

In conclusion, establishing a TNN improved access to specialist care for rural veterans. A telenephrology champion and local APPs with renal training facilitate program adoption and expansion.

Funding

  • Veterans Affairs Support