Addressing Chronic Kidney Disease in Texas: A Work in Progress

Transcription

1 Addressing Chronic Kidney Disease in Texas: A Work in Progress Elaine Braslow, M.Ed. ESRD Prevention Program Coordinator Texas Department of State Health Services Austin, Texas 2009

2 Texas ESRD Prevention Program Background Enabling Legislation CKD Task Force Campaign Progress to Date Next Steps

3 Chronic Kidney Disease Task Force Established through passage of HB 1373 (80 th Texas Legislature, 2007). Members appointed by Governor, Lt. Governor, and Speaker of the House. Legislation directed Task Force to study the burden of chronic kidney disease (CKD) in Texas, summarize findings and make recommendations to address the problem. Task Force submitted findings & recommendations in report to legislature, January Full text of report:

4 Chronic Kidney Disease Task Force Members A. Osama Gaber, MD, Chair Methodist Hospital Houston Carolyn Atkins, BS, RN, CCTC Dallas Louise Clement, MS, RD, LD, CSR Renal Dietitian Lubbock Roberto Collazo Maldonado, MD Nephrologist Dallas The Honorable Robert Deuell Texas Senate Lisa Genna, MEd DSHS Austin The Honorable Ryan Guillen Texas House of Representatives The Honorable Chris Harris Texas Senate The Honorable Susan King Texas House of Representatives Rita Littlefield Texas Renal Coalition Austin Elena Longoria Marin, MD Harlingen Jayaram Naidu, MD Odessa Charles Nolan, MD UTHSC San Antonio Marolyn Stubblefield, MA, MBA NKF San Antonio Smita Vaidya, PhD UTMB Galveston Susan Wiggans Quest Diagnostics Houston Marinin Renz Williams Scott & White Temple

5 CKD Affects Millions of People 26 million Americans have CKD. Millions more are at risk and may not know it. >500,000 ESRD patients are undergoing RRT. U.S. has 2 nd highest rate of new cases of ESRD worldwide. (2008 USRDS) The Problem U.S.

6 2006 Medicare Costs: $49 billion for CKD $23 billion for ESRD CKD is Expensive The Problem U.S. CKD Without ESRD (2008 USRDS)

7 Kidney Disease in Texas Texas is reported to have 2 nd highest prevalence and costs of CKD in the nation. Texas is reported to have the highest incidence of ESRD in the country. 42,000 Texans are receiving RRT. The incidence of ESRD in Texas exceeds the national rate. The Problem Texas (2008 USRDS; ESRD Network 14)

8 The Problem Texas Data Source: ESRD Network 14, Annual Reports

9 Task Force Findings CKD is a major public health problem that is: Under-recognized Under-diagnosed Under-treated Prevention of risk factors can prevent/delay CKD. Simple blood and urine tests can identify CKD at early stages. Early detection, treatment and management can delay disease progression. Evidence-based guidelines are underused. Task Force Findings

10 Task Force Findings Diabetes, hypertension, and CVD are the primary diagnoses of CKD patients. Most CKD patients die of heart disease before they reach ESRD. CKD affects populations disproportionately African-Americans, Hispanics, American Indians, and Asian/Pacific Islanders are at highest risk. CKD patient care is fragmented. Task Force Findings Texas lacks reliable incidence, prevalence, and cost data for CKD.

11 The Task Force recommends a public health approach across healthcare systems to: Increase awareness of CKD, its precursors and comorbidities. Educate patients and providers on importance of early detection. Educate providers on evidence-based standards of care for treatment and management to delay progression and lessen complications. Establish a coordinated system of care. Task Force Recommendations

12 Public Health Approach Primary Prevention & Early Detection Clinical Prevention & Treatment Systems Change Data Collection & Surveillance Public Health Across Systems

13 Primary Prevention & Early Detection Through Education & Outreach Increase awareness among at-risk patients & general population through multi-media campaign. Educate healthcare providers on importance of testing at-risk patients. Prevention Early Detection

14 ESRD Prevention Awareness Campaign Texas Legislature appropriated funds in FY08 FY09 for Department of State Health Services (DSHS) and the Texas Renal Coalition to develop & implement an ESRD Prevention Program for the state. The campaign launched in 2008 in Lubbock, Laredo, Rio Grande Valley, Tyler, Beaumont-Port Arthur, Corpus Christi, and San Antonio. Prevention Early Detection

15 Urges individuals with diabetes, high blood pressure or a family history of kidney disease to get tested. Prevention

16 Program components: TV & radio PSAs Print ads Messages in pharmacies & grocery stores Educational materials Prevention

17 Prevention

18 Save their Kidneys Dual campaign directed to healthcare providers. Urges providers to test their at-risk patients. Program components: Direct mailings to physicians, nurses, dietitians, pharmacists Professional exhibit and materials Ads in Texas Medicine & Texas Family Physician Articles in Texas Medicine & Texas Medical Board Bulletin Savekidneys.com website Early Detection Save their kidneys

19 Early Detection Save their kidneys

20 Evaluation In September 2008, UTMB conducted evaluation to determine impact of PSAs in first tier sites: Laredo, Lubbock, McAllen, Harlingen. Evaluation focused on 3 short-term outcomes: 1. Exposure to PSAs 2. Impact on awareness of risk factors 3. Change in behavior Surveys administered through DSHS community diabetes programs. Evaluation

21 Impact of PSAs 98% of participants reported at least one change in awareness of risk factors, knowledge of disease, or behaviors. Evaluation

22 Impact of PSAs -- Behaviors 90% encouraged to talk to their doctors about CKD. 87% encouraged to get tested for kidney disease. 80% encouraged to make at least one lifestyle change. Evaluation

23 Evaluator Recommendations Implement wider dissemination of PSAs. Expand education messages to health care providers. Evaluation Summary available at: Evaluation

24 Clinical Prevention & Treatment Through Professional Education Adopt K/DOQI Guidelines develop physician practice tools, flow charts to facilitate implementation Implement guidelines through systems physician practices, health plans, insurers Educate medical community on evidence-based guidelines for primary prevention, early detection, management and treatment of CKD Prevention Treatment Target primary care physicians they are first line of defense

25 Systems Change Through Education & Advocacy Implement guidelines through systems physician practices, health plans, insurers. Educate providers and support legislation on automatic egfr reporting by labs performing serum creatinine determinations on individuals 18 years and older. Work with National Committee for Quality Assurance (NCQA) to include nephropathy screening for individuals with hypertension as a HEDIS measure. Systems Change

26 Quality Care Initiative Texas is one of 10 states selected by CMS to participate in initiative to improve CKD quality measures: Timely testing of micro-al to detect early kidney disease due to diabetes; Prescribing ACE and/or ARBs to slow progression of CKD in patients with diabetes and hypertension Increasing use of AV fistula TMF Health Quality Institute is the lead. Partners include: NKF, ESRD Network 14, Texas Renal Coalition, DSHS and CKD Task Force.

27 Data Collection & Surveillance Incorporate CKD surveillance into existing surveillance programs BRFSS. Use data from existing surveillance programs to estimate at-risk population. Develop & implement research study to identify incidence, prevalence and costs of CKD in Texas. Data

28 Outcomes of 81st Legislative Session HB 2055: extends CKD Task Force through August 31, Develop cost-effective plan for prevention, early screening, diagnosis and management of CKD for the state s population; Develop a plan for surveillance and data analysis to assess the impact of CKD in the state; Outcomes Submit findings and recommendations to Governor, Lt. Governor, Speaker, presiding officers of identified Senate and House Committees.

29 Outcomes of 81st Legislative Session HB 2330: relates to laboratory tests measuring kidney function. Lab requirement Physician requirement Exemptions Outcomes

30 Outcomes of 81st Legislative Session 2 CKD Riders to General Appropriations Bill 1. : allocates funds to continue campaign during biennium. 2. CKD Study: allocates funds to conduct study to determine CKD incidence, prevalence and costs in Texas. Outcomes

31 Key Elements Task Force subject matter experts legislators Partners Texas Renal Coalition, TMF, ESRD Network, NKF, DSHS Texas Diabetes Program, DSHS CVD Program, Texas Medical Association, Texas Medical Board Advocates campaign & evaluation results Task Force Report Success Factors

32 Next Steps Task Force put recommendations into action assign/recruit experts for key projects/committees plan, implement, evaluate CKD Study define objectives establish steering committee study design/methodology/deliverables/outcomes define new markets expand messaging new components/creatives Next Steps

33 Thank you. Texas ESRD Prevention Program