Pediatric Nephrology Co-Management at UNC Chapel Hill: A Quality Improvement Project
Creators: name: Vuong, Kim
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: Research Question: What variables impede or improve co-management of pediatric patients with nephrologic conditions who are referred to pediatric subspecialty services? Importance: The need for pediatric nephrologists has grown faster than the workforce can expand to meet it, and 48% of pediatricians report too few specialists to meet the needs of their patients, with wait times on average of 6.7 weeks. General pediatricians are the initial providers of care for these patients before they are seen by pediatric nephrologists. Specific Aims: I used the UNC pediatric nephrology referral service as a representative environment in which to gather data about areas of improvement for co-management. With the assistance of my faculty mentors, I surveyed primary care providers to determine their comfort with initial work-up and management of the most common conditions referred to UNC, and assessed ways to improve communication between offices, and clarity of management plans. Methods: I used EPIC referral provider data to identify those who have previously referred patients to UNC pediatric nephrology. I then invited those providers to participate voluntarily in our web-based survey of their referral experiences. Recruitment methods included fax, office phone, and email addresses where information was available. Survey results were anonymous; in this preliminary analysis, I provide descriptive statistics such as counts, frequencies, and cross tabs with respect to EPIC access. I used Chi square tests to compare distance from UNC with satisfaction with wait time and received assessments, notes, and treatment plans. I accepted P values ≤ 0.05 to be statistically significant. Results: Of the 177 potential providers who received recruitment messages, 10 responded, for a response rate of 5.6%. Most responders were female (70%), between 35 and 54 years old (60%), and practice in suburban settings (50%) less than 25 miles from UNC Health Care Pediatric Nephrology service in Chapel Hill, North Carolina (70%). Primary care providers with EPIC access receive copies of consultation notes more frequently than do those without, but also report receiving slightly too much communication. Most providers (80%) felt that the most valuable content in consultation notes is clear management plans and education about the patient’s diagnosis. Most providers (80%) are satisfied with the frequency and content of current communication with UNC Pediatric Nephrology. However, many are still uncomfortable with conditions including steroid resistant and steroid-sensitive nephrotic syndrome, chronic kidney disease, and autoimmune disease. Many primary care providers (70%) are interested in receiving further education, which could be an opportunity to improve upon the PCP-specialist relationship and empower PCPs to co-manage and know when to refer their pediatric patients with nephrologic conditions. However, these findings are limited by the small response rate and the lack of identifying information to assess whether these respondents are representative of the larger population of referring providers. A larger survey sample would help us understand much more about this dynamic working relationship to enhance patient care and access, advance patient and provider education, and, ultimately, improve patient outcomes and provider satisfaction.