Potentially Preventable Hospitalizations

Transcription

1 Potentially Preventable Hospitalizations What does kidney disease have to do with it? Elaine Braslow, MEd September 29, 2015

2 About your kidneys What do the kidneys do? Prevent buildup of wastes and extra fluid in the body. Keep electrolytes (sodium, potassium, phosphate) balanced. Produce hormones that: Regulate blood pressure Make red blood cells Keep bones strong Kidneys play a vital role in keeping us alive and well. Maintain homeostasis.

3 What is kidney disease? Kidneys are damaged. Cannot filter blood as they should. Waste & other fluid build up causing harm to other body organs. If not detected and treated.. Kidney disease can lead to many serious & lifethreatening problems. Complications Cardiovascular disease (heart attack, angina, coronary heart disease, stroke, pericarditis, hypertension) Edema (pulmonary, extremities) Neurologic (nerve damage, uremic encephalopathy) Weakened bones that can easily break Decreased ability to fight off infections Anemia Uremia Metabolic acidosis Electrolyte imbalance Kidney failure

4 Chronic Kidney Disease (CKD) Abnormalities of kidney structure or function for >3 months. Acute Kidney Injury (AKI) Abrupt loss of kidney function due to: Lack of blood flow to kidneys Direct damage Exposure to nephrotoxic agents Inflammation Blockage Detected through blood & urine tests that show serum creatinine level and urine output. Can be caused by underlying illness. Long-term/progressive. Usually caused by underlying illness. More likely to result from certain exposures, often in the hospital setting.

5 What causes CKD? Infections/ Blockage Autoimmune Diseases Acute Kidney Injury Metabolic Syndrome Obesity Proteinuria Abnormal Blood Lipids Heart Disease Overuse of NAISDS Smoking Hematuria Hypertension Physical Inactivity Poor Glycemic Control Poor Blood Pressure Control Kidney Disease Diabetes Poor Diet Too Much Salt Stress Race/Ethnicity Age Tubular Disorder Genetic Syndromes GNP Family History

6 Prevalence Prevalence of cardiovascular conditions by CKD status, 2012 Medicare 5 percent sample with patients 66 and older % % % 19.1% 26.4% 24.2% % 9.1% 9.6% 6.7% 7.5% 2.4% 1.3% 4.5% ASHD AMI CHF CVA-TIA PAD AFIB CA/VA No CKD Any CKD Data source: Medicare 5 percent sample. Patients age 66 and older, alive, without end-stage renal disease, and residing in US on 12/31/2012 with fee-for-service coverage for entire calendar year. Abbreviations: ASHD, atherosclerotic heart disease; AMI, acute myocardial infarction; CHF, congestive heart failure; CVA-TIA, cerebrovascular incident; PAD, peripheral artery disease; AFIB, atrial fibrillation; CAVA, cardiac arrest/ventricular arrhythmias. USRDS 2014 ADR.

7 Prevalence US Prevalence of CHF, DM and CKD % 14% 12% 13.6% 13.6% 12.6% 10% 8.7% 10% 8% 7.6% CHF DM 6% CKD 1-4 4% 2% 2.2% 2.6% 2.2% 0% NHANES USRDS 2013 ADR

8 What causes AKI? Prerenal: sudden decrease in blood flow to kidneys, resulting in loss of kidney function. Due to systemic causes & exposures. Susceptibility CKD Diabetes Heart disease Other chronic disease (liver, lung) Cancer Dehydration Anemia Advanced age Female gender African American race Exposure Sepsis Critical illness Circulatory shock Burns/trauma Cardiac surgery Major non-cardiac surgery Nephrotoxic drugs Iodine contrast agents Poisonous plants Intrinsic underlying kidney condition Postrenal blockage

9 Complications of AKI CVD Hypertension Edema (pulmonary & extremities) Metabolic acidosis Uremia High potassium levels leading to muscle weakness, paralysis, arrythmias Kidney failure AKI on CKD accelerates movement to end-stage renal disease. High rates of hospitalizations, repeat hospitalizations, and extended stays High rates of morbidity and mortality

10 Kidney disease & hospitalizations CKD Long-term/progressive Hospitalizations usually triggered by underlying cause Hospitalization rates increase by stage & comorbidity CKD is associated with high rates of rehospitalizations

11 Hospitalization triggered by diabetes blood sugar damages filters protein leaks into urine wastes and extra fluid build up in body FLUID OVERLOAD HOSPITAL Hospitalization triggered by underlying cause

12 Admissions per 1,000 patient years Adjusted all-cause hospitalization rates in Medicare patients age 66 and older, by cardiovascular disease, diabetes mellitus, CKD status and stage, No CKD CKD 1-2 CKD 3 CKD No DM or CVD DM (no CVD) CVD (no DM) DM + CVD Data source: Medicare 5 percent sample. January 1, 2012 point prevalent Medicare patients, age 66 and older. Adj: age/sex/race/prior year hospitalization/comorbidity; rates by one factor are adjusted for the others. USRDS 2014 ADR.

13 Rehospitalization or death within 30 days from live hospital discharge in patients age 66 & older, by kidney function, 2012 Data Source: Special analyses, USRDS ESRD Database and Medicare 5 percent sample. January 1, 2012 point prevalent Medicare patients age 66 & older on December 31, For general Medicare: January 1, 2012 point prevalent, Medicare patients age 66 & older, discharged alive from an all-cause index hospitalization between January 1, 2012, and December 1, 2012, unadjusted. CKD determined using claims for Abbreviations: CKD, chronic kidney disease; ESRD, end-stage renal disease; rehosp, rehospitalization.

14 Kidney disease & hospitalizations AKI Serious emergency with high mortality. AKI is largely seen among hospitalized patients, where 45% of patients admitted to the ICU and 20% of hospitalized patients are affected worldwide. 2 Patients with AKI have longer hospital lengths of stay in part due to its effect on other organ function. Patients with AKI have high rates of rehospitalization. 2 Li PKT, Burdmann EA, Mehta RL. Acute kidney injury: Global health alert. J Nephropathol, 2(2): April /JNP

15 Number of hospital discharges by disease/condition as a principal or secondary diagnosis, all ages, Texas, 2013 Stage 1 CKD 1,433 Stage 2 CKD 11,863 Stage 3 CKD 75,669 Stage 4 CKD 28,191 Stage 5 CKD 5,116 Unspecified CKD 89,051 ESRD 96,907 AKI 240, , , , , , ,000 Number of Discharges Hospital Data Source: Texas Health Care Information Collection (THCIC), Inpatient Hospital Discharge Public Use Data File, Population Data Source: 2013 Texas Vital Statistics Unit, Texas Department of State Health Services. Results do not include HIV and drug/alcohol use patients. Abbreviations: CKD, chronic kidney disease; ESRD, end-stage renal disease; AKI, Acute Kidney Injury.

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17 How do we prevent hospitalizations associated with kidney disease? Increasing awareness, education, and early detection Ensuring patient-centered care Advancing public policy

18 Improving the understanding, detection and management of kidney disease Partnerships

19 Kidney Disease Care Model: Clinical & Public Health Strategies Patientcentered care Stage Normal Kidney Function Pre-Disease Early Stages of Kidney Damage Stages 1-2 Advanced Stages of Kidney Disease Stages 3-4 Kidney Failure Stage 5 Clinical Assess for CKD risk factors Treat/manage risk factors Screen for kidney damage Diagnose/treat CKD to slow progression Evaluate/manage comorbidities Refer to case management Treat /manage CKD and comorbidities to slow progression Refer to nephrology and case management Prepare for renal replacement therapy Kidney replacement by dialysis or transplant Monitor/manage RRT to decrease adverse outcomes Public Health Primary Prevention Secondary Prevention Tertiary Prevention Promote healthy lifestyle behaviors Increase awareness of CKD risk factors Encourage at-risk patients to get tested Educate providers on clinical practice guidelines for CKD Promote implementation of clinical guidelines through healthcare systems Educate patients/caregivers on disease management to include diet, medication use, and healthy lifestyle behaviors Refer patients/caregivers to support services Educate providers on clinical guidelines and promote their implementation Educate patients/caregivers on disease management, renal replacement options, and maintaining healthy lifestyle behaviors Refer patients/caregivers to support services Educate providers to implement clinical guidelines and coordinate multidisciplinary care teams Quarternary Prevention Encourage patients/ caregivers to maintain healthy lifestyle behaviors Refer patients/caregivers to support services Educate providers to implement clinical guidelines to mitigate adverse outcomes of treatment Targets General Public/At-Risk Patients/ Providers Patients/ Caregivers/ Providers Patients/ Caregivers/ Providers Patients/ Caregivers/ Providers

20 How do we operationalize? Increasing awareness, education, early detection Love Kidneys social marketing campaign Community events Partnering with other chronic disease programs Patient-centered care Tag on to professional conferences Patient symposia Me & my doctor articles Webinars Advancing public policy Patient advocacy workshops Kidney Day at the Capitol Legislation

21 Media Description Audience Television/cable :60 and :30 PSAs General public/patients Radio :60 spots General public/patients Digital Banner ads on Google Search, Batanga, Digilant General public/patients Providers Social Facebook, twitter, apps General public/patients Print Ads in Texas Medicine and Texas Family Physician Providers LoveKidneys.com Comprehensive website General public/patients Providers

22 LoveKidneys.com

23 Love Kidneys banners

24 Provider site

25 Physician ad & banners

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27 Support & assist with partner events Professional education conferences Patient symposia Community screening/education events Advocacy workshops & Kidney Day at the Capitol Support & assist Love Kidneys Campaign Peer review clinical content for website Articles for Me & My Doctor TMA QI project

28 KEEP Healthy Events Sept 26: Lubbock Risk survey Body Mass Index (BMI) Blood pressure check UACR Educational materials Opportunity to speak with a healthcare professional Ask a dietitian QuitLine Resource/referral information

29 Kidney Day at the Capitol February 15, 2011

30 Partnerships Diabetes Program CDEPs Kidney education Host KEEP Healthy event(s) Evaluation/campaign extension Tobacco Work Group Brings chronic disease programs together across common theme Heart & Stroke Partnership Million Hearts

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