Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of strategies to increase care coordination and collaboration for chronic kidney disease (CKD) (i.e. primary care/nephrology and team based approaches) in slowing CKD progression and reducing CKD complications?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

We are interested in the benefits derived from care coordination programs compared to usual care for CKD; and we are also interested in comparisons of various care coordination strategies to each other.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Any patients with CKD, and also CKD patients with comorbidities or at risk of comorbidities

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

We are interested in subpopulations with high rates of CKD, such as African Americans, Hispanics, obese, and elderly people. We are also interested in disparity populations with poor access and underutilization of prevention services, regular primary care, and specialists, such as populations with lower economic and educational status, and inner city and rural populations.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Benefits would be the arrest or slowing of the progression of CKD to end stage renal disease (ESRD), and better control of typical CKD complications and comorbidities such as obesity, cardiovascular disease and diabetes.

Describe any health-related risks, side effects, or harms that you are concerned about.

None expected

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Diabetes mellitus
• Obesity

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Prevalence of CKD is high and increasing along with the associated chronic conditions of obesity, cardiovascular disease, and diabetes. Progression of CKD to ESRD is very costly to individuals, payers, and society and is accompanied by disability and impairment.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was identified in our AHRQ/EHC sponsored topic identification project. Among a large number of CKD topics, a group of stakeholders ranked this as a high priority topic.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Providers and health systems need motivation for care coordination programs in terms of the expected benefits, and they need advice on which care coordination strategies are most affordable and effective, particularly for disparity and underutilization populations.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Convincing evidence on effective care coordination programs will potentially change guidelines and practice.

Describe the timeframe in which an answer to your question is needed.

No particular timeframe, rather this is an ongoing and increasing problem for society.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

CKD has a higher prevalence among African Americans, Hispanics, obese, and elderly people, disparity populations with poor access and underutilization, lower economic and educational status, and inner city and some rural populations.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Convincing evidence on effective care coordination programs will potentially change guidelines and practice.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program