B5- Dolph Chianchiano.2.ppt

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  • Read aloud, and comment if desired.
  • The components titled on the following pages provide the participants with the knowledge to change practice behaviors and leverage better patient outcomes. A protocol allows patients to timely identify CKD and diabetes using easy, available and cost-efficient tests. Pharmacologic guidance allows clinicians to understand and choose the best therapy. Finally, two case studies managed by CKD/diabetes care teams allow participants to learn how to apply the protocol tests and phamacologic guidance, and timely treat.
  • Read aloud, and comment if desired.
  • Read aloud, and comment if desired.


  • 1. Improving Patient Outcomes in Chronic Kidney Disease in Diabetes via Multiple Educational Formats
    • A collaboration between the National Kidney
    • Foundation and the Diabetes
    • Prevention and Control Program (DPCP)
    • New York State Department of Health
    • Fall, 2006-December, 2007
    • Session: B5-25664 Dolph Chianchiano
  • 2. Rationale
    • Rationale
    • The National Kidney Foundation (NKF)
    • learned that many primary care clinicians
    • were not routinely screening for both
    • chronic kidney disease (CKD) and diabetes;
    • co-morbid diseases that adversely impact
    • patient outcomes. NKF wanted to increase
    • early intervention to improve patient
    • outcomes and felt this goal could be
    • reached by offering continuing education to
    • primary care clinicians.
  • 3. Rationale Cross-sectional analysis of tests at a regional Lab Corp facility, April1, 2002, through March 31, 2003.
  • 4. Rationale
    • Random National Sample of Nephrologists, Family Physicians, and General Internists
  • 5. Objective
    • Objective
    • In response to the growing prevalence
    • of co-morbid CKD and diabetes, the need
    • to screen for both these diseases during
    • patient encounters, and the recent release
    • of NKF’s “Clinical Practice Guidelines and
    • Recommendations for Chronic
    • Kidney Disease and Diabetes,” educate
    • clinicians on timely identification and
    • treatment strategies via multiple
    • educational formats and delivery
    • methodologies.
  • 6. 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
  • 7. 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
  • 8. 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.
  • 9. 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.
  • 10. 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
  • 11. 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
  • 12.  
  • 13. 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
  • 14.
    • Three Key Program Components
  • 15.
    • Easy and cost-efficient protocol for
    • timely identification
    • of CKD in diabetes *
    • *also referred to as Diabetic Kidney Disease (DKD)
  • 16. Pharmacologic Guidance 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
  • 17. Two Case Study Illustrating Timely Treatment of CKD in Diabetes Through Medical, Behavioral, and Nutritional Team Management
  • 18. Outcomes
    • Outcomes
    • Three-hundred and forty clinicians attended
    • the 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.
  • 19. Conclusion
    • Conclusions
    • Educating clinicians about urgent public
    • health needs, in multiple educational formats
    • and delivery methodologies, are
    • effective means for increasing clinician
    • awareness and enhancing quality of care
    • NKF hopes to take the Grand Rounds
    • symposium to additional sites in New York state
  • 20.
    • Questions