B5- Dolph Chianchiano.2.ppt
Transcript of B5- Dolph Chianchiano.2.ppt
Improving Patient Outcomes in Chronic Kidney
Disease in Diabetes via Multiple Educational Formats
A collaboration between the National KidneyFoundation and the Diabetes
Prevention and Control Program (DPCP)New York State Department of Health
Fall, 2006-December, 2007 Session: B5-25664 Dolph Chianchiano
Rationale
Rationale
The National Kidney Foundation (NKF)learned that many primary care clinicianswere not routinely screening for bothchronic kidney disease (CKD) and diabetes;co-morbid diseases that adversely impactpatient outcomes. NKF wanted to increaseearly intervention to improve patientoutcomes and felt this goal could bereached by offering continuing education toprimary care clinicians.
Rationale
Cross-sectional analysis of tests at a regional Lab Corp facility, April1, 2002, through March 31, 2003.
Objective
ObjectiveIn response to the growing prevalence of co-morbid CKD and diabetes, the needto screen for both these diseases duringpatient encounters, and the recent releaseof NKF’s “Clinical Practice Guidelines andRecommendations for ChronicKidney Disease and Diabetes,” educateclinicians on timely identification andtreatment strategies via multipleeducational formats and deliverymethodologies.
Partners
Partners
• National Kidney Foundation’s national office and New York state affiliates
• New York State Department of Health’s Diabetes Prevention and Control Program (DPCP)
• New York state Community Diabetes Coalitions
Process
Process to Develop and Deliver Programs
• Conduct needs assessment and evaluate data from clinicians and NKF’s KEEP screening program to drive learning objectives and content
• Identify target audience likely to impact patients: selected primary care physicians, nurses, pharmacists, and dietitians, all members of a CKD and diabetes care team
• Identify learning objectives with outcomes that can change clinical practice
Select Education Delivery Modes
Based on Adult Learning Principles, select formats for delivering continuing education:– Live symposium using slides and case studies to
invite dialogue and interaction– Audio/video teleconferencing delivery to rural areas
to extend reach and accessibility to learning– “Team-teaching” by faculty: nephrologist and
primary care or endocrinologist to model desired team behaviors in the clinical setting
– Support learning with “CKD Pack” of printed materials for clinicians and patients for use after the live program.
Process (cont’d)
Process (cont.)
• Select sites– Local affiliates collaborate with hospitals that support
symposia for clinical education
• Recruit workgroup for content development– Utilized five national experts on CKD, diabetes, pharmacy,
dietetics, and primary care for integrated approach
• Develop content - included: – an easy and cost-efficient protocol for timely identification; – pharmacologic guidance for practical implementation; – case studies to illustrate timely treatment using a team
approach.
Process (cont.)
Process (cont.)
• Recruit and train faculty– recruited local faculty considered knowledgeable,
good teachers and speakers– each faculty consisted of a nephrologist and
endocrinologist to model collaboration skills• Design participant educational packet to extend
learning:– Patient education resources from NKF inventory for
the office and to support patient teaching– Professional education resources on GFR, CKD and
Diabetes• Design participant and faculty program manuals
– Printed handout with program agenda and slides
Process (cont.)
Process (cont.)
• Create promotion and marketing plan– Designate symposium as a “Grand Rounds” to signify its importance
and encourage attendance– Sent email blitzes to potential participants,– Provided posters for hospital sites and local marketing materials for
affiliates to distribute
• Facilitate continuing education credits– Provide CME and CE credits for multiple disciplines to encourage
attendance.
• Evaluate participant and faculty feedback– Used Scantron evaluation forms for ease of processing– Analyze results for strengths and areas of improvement for future
programs
Learning Objectives
• State the public health significance of the CKD and diabetes prevalence in New York State, the U.S. and around the world
• Describe the use of eGFR (estimated Glomerular Filtration Rate) and other methods for timely identification of CKD in diabetes
• Discuss the management of CKD in diabetes using timely behavioral, nutritional and medical interventions to improve patient outcomes
Easy and cost-efficient protocol fortimely identification of CKD in diabetes*
*also referred to as Diabetic Kidney Disease (DKD)
Recommended Dosing and Dosing Adjustments for Drugs Used to
Achieve Glycemic Control in CKD Stages 3 and 4*
* NKF’s KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease (AJKD, 2007), www.kdoqi.org
Pharmacologic Guidance
Two Case Study Illustrating Timely Treatment of CKD in Diabetes Through
Medical, Behavioral, and Nutritional Team Management
Outcomes
Outcomes
Three-hundred and forty clinicians attendedthe symposium statewide: • 98% indicated satisfaction with the program • 95% said they gained new knowledge • 85% said they would make changes in their
practice• 99% said they would recommend the
program to their peers.
Conclusion
Conclusions
Educating clinicians about urgent publichealth needs, in multiple educational formats
and delivery methodologies, areeffective means for increasing clinician
awareness and enhancing quality of care
NKF hopes to take the Grand Roundssymposium to additional sites in New York
state