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Smekal MD, Donald M, Beanlands H, Straus S, Herrington G, Waldvogel B, Sparkes D, Delgado M, Bello A, Hemmelgarn BR. Development and Preliminary Psychometric Testing of an Adult Chronic Kidney Disease Self-Management (CKD-SM) Questionnaire. Can J Kidney Health Dis 2021; 8:20543581211063981. [PMID: 34925864 PMCID: PMC8671825 DOI: 10.1177/20543581211063981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Self-management focused interventions to slow chronic kidney disease (CKD) progression are increasingly common. However, valid self-report instruments to evaluate the effectiveness of self-management interventions in CKD are limited. Objective: We sought to develop and conduct preliminary psychometric testing of a patient-informed questionnaire to assess aspects of CKD self-management for patients with CKD categories G2-G5 (not on kidney replacement therapy [KRT]). Design: Self-administered electronic questionnaires (multiphase). Setting: Online. Sample: Canadian adults with CKD categories G2-G5 (not on KRT) Methods: The CKD-SM questionnaire was developed and tested in 4 phases. First, we used a content coverage matrix to identify potential questionnaire items based on existing self-efficacy questionnaires, self-management theories, and patient-identified priorities. Second, the draft questionnaire was reviewed by a multidisciplinary expert panel using percent acceptance to finalize the questionnaire. Third, we tested an electronic version of the questionnaire with patients with CKD, evaluating preliminary psychometric properties including internal consistency, face validity, and content validity. Finally, we tested the questionnaire within a CKD self-management intervention study and collected data on internal consistency, test-retest reliability, and pre-post responsiveness. Results: We identified 22 potential questionnaire items for the first round of expert panel review. Thirteen items were retained in the first round. Eleven additional items were tested in the second review round and all were retained. Of the 24 items retained following expert review of the questionnaire, 21 had greater than 85% acceptance (content validity index [CVI], 0.75-1.00) and 3 items had 75% acceptance (CVI, 0.5). Thirty patients with CKD from across Canada participated in the pilot testing, and 29 patients participated in the CKD self-management intervention study. In the pilot test, several participants requested inclusion of a question that explicitly addressed mental health; consequently, an additional item relating to mental health was included prior to the intervention study (final questionnaire total was 25 items). Internal consistency (Cronbach α) was high for both the pilot (0.921) and intervention study (0.912). Preintervention test-retest reliability, measured with intraclass correlation coefficient, was acceptable (0.732, 95% confidence interval, 0.686-0.771, P < .001), and paired pre/postintervention comparison, measured with Wilcoxon sign-rank, demonstrated significant increases in self-management (P < .05) despite stable preintervention test-retest responses. Participants were satisfied with the content, wording, and design. Limitations: The sample sizes were small for each component of the analysis, and the sampling was consecutive/convenience-based. Conclusions: We used self-management theories, patient-identified self-management needs, expert review, and conducted preliminary psychometric testing to finalize a CKD self-management questionnaire for patients with G2-G5 CKD (not on KRT). The finalized questionnaire assesses aspects of self-management for individuals with CKD and may be particularly helpful as a tool to evaluate self-management interventions among patients with CKD.
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Affiliation(s)
| | - Maoliosa Donald
- Department of Medicine, University of Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Gwen Herrington
- Can-SOLVE CKD Network-Patient Partner, Vancouver, BC, Canada
| | - Blair Waldvogel
- Can-SOLVE CKD Network-Patient Partner, Vancouver, BC, Canada
| | - Dwight Sparkes
- Can-SOLVE CKD Network-Patient Partner, Vancouver, BC, Canada
| | - Maria Delgado
- Can-SOLVE CKD Network-Patient Partner, Vancouver, BC, Canada
| | - Aminu Bello
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, AB, Canada.,Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Smekal MD, Bello AK, Donald M, Zaidi D, McBrien K, Nicholson K, Novak E, Hemmelgarn B. Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative. BMJ Open 2021; 11:e046068. [PMID: 34753751 PMCID: PMC8578991 DOI: 10.1136/bmjopen-2020-046068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gaps in identification, medical management and appropriate referral for patients with chronic kidney disease (CKD) are evident. OBJECTIVE We designed and implemented an interactive educational intervention (accredited workshop) to improve primary care providers' awareness of tools to support guideline-concordant CKD management. DESIGN We used the Kern method to design the educational intervention and targeted the accredited workshops to primary care team members (physicians, nurses and allied health) in Alberta, Canada. We conducted anonymous pre-workshop and post-workshop surveys to identify practice-specific barriers to care, identify potential solutions, and evaluate provider confidence pre-intervention and post-intervention. We used non-parametric statistics to analyse Likert-type survey data and descriptive content analysis to categorise responses to open-ended survey questions. RESULTS We delivered 12 workshops to 114 providers from September 2017 through March 2019. Significant improvements (p<0.001) in confidence to appropriately identify, manage and refer patients with CKD were observed. Participants identified several patient-level, provider-level, and system-level barriers and potential solutions to care for patients with CKD; the majority of these barriers were addressed in the interactive workshop. CONCLUSIONS The Kern model was an effective methodology to design and implement an educational intervention to improve providers' confidence in managing patients with CKD in primary care. Future research is needed to determine if these perceived knowledge and confidence improvements affect patient outcomes and whether improvements are sustained long term.
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Affiliation(s)
| | - Aminu K Bello
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Deenaz Zaidi
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry McBrien
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ellen Novak
- Alberta Kidney Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Donald M, Smekal MD, Elliott MJ, McBrien K, Weaver RG, Manns BJ, Tonelli M, Bello A, Straus SE, Scott-Douglas N, Jindal K, Hemmelgarn BR. Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study. BMC Nephrol 2021; 22:332. [PMID: 34615462 PMCID: PMC8496057 DOI: 10.1186/s12882-021-02533-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical pathways aim to improve patient care. We sought to determine whether an online chronic kidney disease (CKD) clinical pathway was associated with improvements in CKD management. METHODS We conducted a retrospective pre/post population-based cohort study using linked health data from Alberta, Canada. We included adults 18 years or older with mean estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. The primary outcome was measurement of an outpatient urine albumin creatinine ratio (ACR) in a 28-day period, among people without a test in the prior year. Secondary outcomes included use of guideline-recommended drug therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins). RESULTS The study period spanned October 2010 to March 2017. There were 84 independent 28-day periods (53 pre, 31 post pathway implementation) including 345,058 adults. The population was predominantly female (56%) with median age 77 years; most had category 3A CKD (67%) and hypertension (82%). In adjusted segmented regression models, the increase in the rate of change of ACR testing was greatest in Calgary zone (adjusted OR 1.19 per year, 95% CI 1.16-1.21), where dissemination of the pathway was strongest; this increase was more pronounced in those without diabetes (adjusted OR 1.25 per year, 95% CI 1.21-1.29). Small improvements in guideline-concordant medication use were also observed. CONCLUSIONS Following implementation of an online CKD clinical pathway, improvements in ACR testing were evident in regions where the pathway was most actively used, particularly among individuals without diabetes.
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Affiliation(s)
- Maoliosa Donald
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Michelle D Smekal
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Meghan J Elliott
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Kerry McBrien
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Robert G Weaver
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Aminu Bello
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Clinical Sciences Building, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Sharon E Straus
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nairne Scott-Douglas
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Kailash Jindal
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Clinical Sciences Building, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Faculty of Medicine & Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Clinical Sciences Building, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
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Smekal MD, Tam-Tham H, Finlay J, Donald M, Thomas C, Weaver RG, Quinn RR, Tam K, Manns BJ, Tonelli M, Bello A, Tangri N, Hemmelgarn BR. Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study. BMC Nephrol 2019; 20:110. [PMID: 30922254 PMCID: PMC6440153 DOI: 10.1186/s12882-019-1269-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Kidney Failure Risk Equation (KFRE) predicts risk of progression to kidney failure and is used to guide clinical decisions for patients with chronic kidney disease (CKD). METHODS The KFRE was implemented to guide access to multidisciplinary care for CKD patients in Alberta, Canada, based on their 2-year risk of kidney failure. We used a mixed methods approach to investigate patients' and providers' perspectives and experiences 1 year following KFRE implementation. We conducted post-implementation interviews with multidisciplinary clinic providers and with low-risk patients who transitioned from multidisciplinary to general nephrology care. We also administered pre- and post-implementation patient care experience surveys, targeting both low-risk patients discharged to general nephrology and high-risk patients who remained in the multidisciplinary clinic, and provider job satisfaction surveys. RESULTS Twenty-seven interviews were conducted (9 patients, 1 family member, 17 providers). Five categories were identified among patients and providers: targeted care; access to resources outside the multidisciplinary clinics; self-efficacy; patient reassurance and reduced stress; and transition process for low-risk patients Two additional categories were identified among providers only: anticipated concerns and job satisfaction. Patients and providers reported that the risk-based approach allowed the clinic to target care to those most likely to experience kidney failure and most likely to benefit from multidisciplinary care. While some participants indicated the risk-based model enhanced the sustainability of the clinics, others expressed concern that care for low-risk patients discharged from multidisciplinary care, or those now considered ineligible, may be inadequate. Overall, 413 patients completed the care experience survey and 73 providers completed the workplace satisfaction survey. The majority of patients were satisfied with their care in both periods with no overall differences. When considering the responses "Always" and "Often" together versus not, there were statistically significant improvements in domains of access to care, caring staff, and safety of care. There were no differences in healthcare providers' job satisfaction following KFRE implementation. CONCLUSIONS Patients and healthcare providers reported that the risk-based approach improved the focus of the multidisciplinary CKD clinics by targeting patients at highest risk, with survey results suggesting no difference in patient care experience or healthcare provider job satisfaction.
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Affiliation(s)
- Michelle D. Smekal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Helen Tam-Tham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Juli Finlay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Maoliosa Donald
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Chandra Thomas
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Robert G. Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Robert R. Quinn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Kin Tam
- Southern Alberta Renal Program, Alberta Health Services, Calgary, Alberta Canada
| | - Braden J. Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta Canada
| | - Aminu Bello
- Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Navdeep Tangri
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta Canada
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Smekal MD, Tam-Tham H, Finlay J, Donald M, Benterud E, Thomas C, Quinn RR, Tam K, Manns BJ, Tonelli M, Bello A, Tangri N, Hemmelgarn BR. Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study. Can J Kidney Health Dis 2018; 5:2054358118763809. [PMID: 29636981 PMCID: PMC5888822 DOI: 10.1177/2054358118763809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background: The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care. Objective: We aimed to describe patient, family, and health care provider’s perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input. Methods: We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey. Results: Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants’ feedback. Conclusions: We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.
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Affiliation(s)
- Michelle D Smekal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Helen Tam-Tham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Juli Finlay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Maoliosa Donald
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Eleanor Benterud
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Chandra Thomas
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Robert R Quinn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kin Tam
- Southern Alberta Renal Program, Alberta Health Services, Alberta, Canada
| | - Braden J Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
| | - Aminu Bello
- Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Canada
| | - Navdeep Tangri
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
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Hemmelgarn BR, Smekal MD, Weaver RG, Thomas C, Benterud E, Tam K, Manns BJ, Tonelli M, Finlay J, Donald M, Tam-Tham H, Bello A, Tangri N, Quinn RR. Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study. Can J Kidney Health Dis 2018; 5:2054358117753618. [PMID: 29375884 PMCID: PMC5777548 DOI: 10.1177/2054358117753618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Risk prediction tools are used in a variety of clinical settings to guide patient care, although their use in chronic kidney disease (CKD) care is limited. Objectives To assess the association of a risk-based model of CKD care on patient care, satisfaction, outcomes, and cost. Design Mixed-methods with a pre-post design. Setting We will use mixed-methods and a pre-post design to evaluate use of the Kidney Failure Risk Equation (KFRE) to guide CKD care. The KFRE will be applied to patients currently followed in nephrology multidisciplinary CKD clinics in Alberta, as well as to new patients being considered for multidisciplinary care. Patients Patients with a 2-year risk of kidney failure ≥10% or estimated glomerular filtration rate (eGFR) ≤15 mL/min/1.73 m2 will be recommended care by a multidisciplinary team coordinated by a nurse clinician and nephrologist, with access to other multidisciplinary resources including dietitians, pharmacists, and social workers as required. Measurements/Methods Focus groups and interviews will be conducted to qualitatively describe patient and provider perspectives of potential barriers and facilitators to implementation of the risk-based approach to CKD care. Patient and provider surveys will also be used to quantify patient and provider satisfaction before and after the intervention. Finally, administrative data will be used to evaluate the association between the risk-based approach to care and outcomes including health care resource use, frequency of testing, modality choice, and death. Conclusions Use of a risk-based model of care has the potential to increase use of optimal treatments such as the use of home dialysis and preemptive kidney transplantation, while reducing costs and poor outcomes related to processes of care such as unnecessary laboratory testing; however, there is also potential for unintended consequences. Our mixed-methods approach will integrate perceptions and needs from key stakeholders (including patients with CKD, their families, and their providers) to guide implementation and ensure appropriate modifications.
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Affiliation(s)
- Brenda R Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
| | - Michelle D Smekal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Robert G Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Chandra Thomas
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Eleanor Benterud
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kin Tam
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Braden J Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
| | - Juli Finlay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Maoliosa Donald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Helen Tam-Tham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Aminu Bello
- Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Navdeep Tangri
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Robert R Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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