A Chronic Care Model Based Quality Improvement (QI) Program to Improve the Care of Patients With Chronic Kidney Disease (CKD)
Condition: Chronic Kidney Disease
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic
Study type: Interventional
Phase: Phase 4

Summary: 
      The goal of this study is to evaluate the impact of a chronic care model (CCM) based quality
      improvement program on 1) outcomes for patients with chronic kidney disease (CKD) and 2)
      adherence to CKD guidelines. This pilot study will evaluate the feasibility of a CCM based
      quality improvement program for patients with CKD and assess potential mechanisms for the
      intervention's effect.

      Hypothesis: Implementing a CCM based quality improvement program including system level
      support in the form of collaborative care, a CKD registry, and provider education will 1)
      reduce systolic BP in patients with poorly controlled hypertension, 2) increase the
      percentage of patients appropriately monitored for metabolic complications, and 3) decrease
      the rate of catheter use in patients initiating dialysis.
    

Detailed description: 
      Research Plan:

      The experimental design is a prospective, randomized controlled trial evaluating the impact
      of a Chronic Care Model (CCM) based quality improvement program on CKD guideline adherence.
      The intervention will focus on three main goals: 1) reduction of BP to target levels, 2)
      appropriate monitoring of patients for metabolic complications of CKD, and 3) reduced use of
      dialysis catheters in patients initiating dialysis. The CKD CCM QI program will include a
      lecture on CKD guidelines and hypertension to all CBOC providers and a centrally located
      pharmacist with access to the CKD registry.

      Methodology:

      Veterans receive primary care at Community Based Outpatient Centers (CBOCs) throughout
      Northeast Ohio. Patients with CKD who receive their primary care at a Northeast Ohio CBOC
      will be eligible for the study. The hypothesis was formulated before data collection.
    

Intervention name(s): Pharmacist based QI program; Usual Care
Intervention type(s): Other; Other
Intervention description(s): Per a study protocol, the pharmacist will call each subject (who has not opted out) and discuss their CKD. In brief, the pharmacist will introduce themselves, ask the subject if they have time to discuss their medical care, inform the subject that they have CKD, briefly discuss CKD, ask the subject if they can come for labs, discuss hypertension management as appropriate, and answer any questions. In addition, for subjects with poorly controlled hypertension, the study pharmacist will arrange for a nutrition consult for a low sodium diet, a mainstay of hypertension management in patients with CKD. Finally, for patients with advanced CKD (GFR <30 mL/min per 1.73 m2) who are not seeing a nephrologist, the study pharmacist will arrange for a nephrology outpatient appointment to assess the need for placement of access for renal replacement therapy.; Patients in the control arm will continue to receive "usual care" from their VA providers.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research