Population Health Strategies for Cardiovascular and Kidney Disease Risk Reduction
Chronic Kidney Disease Change Package 2023
Background
Chronic Kidney Disease (CKD) remains a largely under-recognized and growing public health issue. Despite current guidelines that recommend annual CKD testing for adults with diabetes and/or hypertension, less than 10% of those with hypertension and less than 40% of those with diabetes are completely assessed.
To address this problem, the National Kidney Foundation (NKF) developed Chronic Kidney Disease Change Package 2023 — Population Health Strategies for Cardiovascular and Kidney Disease Risk Reduction. The Change Package provides clinicians, public health practitioners, and quality improvement professionals a systematic approach for transforming CKD care, advancing health equity, and health care quality improvement.
The heart of this systematic approach is a dashboard of process improvement activities for CKD screening, recognition, and management. Selected activities can be adapted based on local practice or clinic needs, resources, and workflows.
The dashboard encompasses six Stages of Change which are generally needed for successful CKD care transformation. Each Stage below is associated with suggested, actionable Change Ideas that are supported by evidence-based, guideline-driven Tools and Resources. These Tools and Resources can be utilized to implement care improvement in priority populations.
CKD remains an under-recognized, growing public health issue.
CKD remains an under-recognized, growing public health issue.
Current guidelines recommend annual CKD testing in adults with diabetes and/or hypertension. Less than 40% with diabetes and less than 10% with hypertension receive guideline testing.
The Chronic Kidney Disease Change Package 2023 provides a systematic approach for care transformation, advancing health equity, and healthcare quality improvement.
At the center is a dashboard of process improvement activities that are adaptable according to local clinic needs, resources, and workflows.
Stages of CKD Change
The dashboard encompasses six Stages of Change for successful CKD care transformation, and each Stage provides actionable Change Ideas supported by evidence-based, guideline-driven Tools and Resources for care improvement activities.
1. Understand CKD and its Management in Primary Care
Review guideline testing and management for CKD and the consequences of unrecognized CKD as a disease multiplier.
2. Assess the Quality of CKD Care in Your Institution
Evaluate the effectiveness of your institution's CKD recognition and management.
3. Building the Business Case to Improve CKD Care
Demonstrate a strong case for change through a health equity lens and healthcare expenditures.
4. Convene a Multi-disciplinary Team
Gather input and participation from your institution's healthcare professionals who are ready for change.
5. Develop the Implementation Plan for Your CKD Intervention
Build a plan that aligns with practice or clinic workflows, patient panels, and available resources.
6. Execute and Measure Your Impact
Measure your CKD intervention to adjust as needed and help ensure it achieves the desired outcomes.
Additional Resources
Review and save a PDF for future reference, or print and share within your organization.
NKF offers a wide range of educational materials, and here's a link to them so that you can learn more about this devastating disease.
Help care teams and improve patient outcomes by using the CKD Heatmap to interpret combined results of eGFR and uACR tests.
