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Kidney Week

Abstract: FR-PO891

Using Population Health Management Program to Promote Patient Choice for Medical Management Without Dialysis

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Neckermann, Isabel, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Bursic, Alexandra E., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Ernecoff, Natalie C., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Bansal, Amar D., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Jhamb, Manisha, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Schell, Jane O., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
Background

Patients with advanced chronic kidney disease (CKD) often start on dialysis as the default treatment option, without a shared decision making discussion (SDM) in which they and their care partners actively choose a renal replacement therapy option that best aligns with their values and wishes. We describe a program to promote SDM and characteristics of patients who chose medical management without dialysis (MMWD).

Methods

As part of the ongoing CKD population health management program at UPMC, high-risk CKD patients not seeing a nephrologist are identified through electronic health record and co-managed with their primary care provider. Patients age>85 years with eGFR <30 ml/min, or those with surprise question (“will you be surprised if this patient dies in next 12 months”) “no” are automatically referred to discuss treatment options with a kidney palliative care advanced practice provider (APP) via telemedicine. Among people who received care in an APP-led decision-making session, we (1) assessed the frequency of selecting MMWD, and (2) compared demographic and clinical characteristics of those who chose MMWD to those who did not.

Results

Of 150 patients who met with an APP, 74 elected MMWD (49%), while 76 (51%) chose to pursue dialysis as a future treatment option. Patients who chose MMWD did not differ by age (mean 88y vs 86y, p = 0.072), gender (59.5% vs. 61.8% female, p=0.77), or eGFR (mean 29.5 vs 32.2, p=0.085) compared to patients who chose dialysis. Additionally, patients who chose MMWD did not have a significantly higher burden of comorbidities compared to those who chose dialysis, including coronary artery disease (59.5% vs. 56.6%, p=0.72), cancer (40.5% vs 38.2%, p=0.77), chronic heart failure (50% vs 46.1%, p=0.63), chronic obstructive pulmonary disease (28.4% vs 21.1%, p=0.30), depression (28.4% vs 35.5%, p=0.35), and diabetes (50.0% vs 50.0%, p=1.00).

Conclusion

CKD population health management program with automated referrals to palliative care-led decision making session is an innovative method to identify and provide patients with CKD increased access to opportunities to discuss treatment options. Our results demonstrate the need for SDM process to promote patient choice in older patients with CKD.