Patient Activation Interventions for Chronic Kidney Disease
1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?
With the rapid growth in the number of Americans who face chronic kidney disease (CKD) and end-stage renal disease (ESRD), more time and resources are being poured into the health care system to serve increasing community-level health needs linked to these diseases. Compounding this trend, more than 75%of those living with kidney disease in America have one or more other chronic conditions, including diabetes and hypertension*. The prevalence of these two conditions is vast; based on 2018 estimates, 10.5% of Americans had diabetes and 46% had hypertension. Given the rigid schedule and symptom burden often experienced by patients receiving in-center hemodialysis for CKD and ESRD, home dialysis and kidney transplantation are often recommended to patients to provide more flexibility to treatment for kidney failure. However, these modalities are heavily underutilized in the U.S. which may be due, in part, to the need for high levels of engagement in patient care and support from care partners and/or family members. Key to how we collectively deal with this health crisis is considering lifestyle changes that can slow the progression of CKD, which can help patients avoid ESRD. In order to achieve this goal, we must consider how providers can most effectively activate patients to consider and pursue lifestyle changes that will slow or halt the progression of CKD, as well as positively influence diabetes and hypertension management. A holistic review of patient activation methods would provide insight to the efficacy of applied methods. Once identified, these methods could be scaled for broader use. * Schneider, K.M., O'Donnell, B.E. & Dean, D. Prevalence of multiple chronic conditions in the United States' Medicare population. Health Qual Life Outcomes 7, 82 (2009).
2. Why are you struggling with this issue?
Effectively activating patients continues to pose a complicated conundrum, as research suggests conflicting findings about the benefits or harms to patients. For providers at the community level, there is a need to better understand what patients need in order to change their lifestyle and daily behaviors, which can lead to more effective management of kidney disease. In absence of this understanding and changes in care practices, those with kidney disease may continue to be guided toward highly time consuming and costly treatment in hemodialysis centers.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
Our short-term goals aim to see improvement in various patient activation measures. Additionally, more clinicians would apply patient activation techniques, such as coaching and providing tools and resources. Our long-term goals aim to improve several patient health outcomes. Achievement of our long-term goals will be evaluated, through three core measures:
- A decrease in patients progressing from CKD to ESRD
- An increase in patients choosing home dialysis with success in managing their kidney failure
- An increase in patients receiving kidney transplants in lieu of dialysis treatment
4. When do you need the evidence report?
5. What will you do with the evidence report?
This evidence report would immediately translate into critically important clinician-focused practice guidelines on how to effectively activate patients. To support the spread and scale of effective models of CKD care, virtual tools could be developed and leveraged that would incorporate research-informed patient activation methods. Additionally, this report would be used for program planning purposes for Quality Improvement Organizations (QIOs) and ESRD networks, with a specific focus on how to provide technical assistance. Finally, more broadly, this research may provide insights for large dialysis organizations on evidence-based practices for engagement with CKD patients and their families, facilitating the design of interventions with CKD patients and families in mind.