Championing Equitable Kidney Care and Demonstrating Community Health Impact in Partnership with University Health

Adapted from the CKD Change Package, the NKF offers an evidence-based Learning Collaborative model that brings together a multidisciplinary team to improve CKD care. The initiative equips systems with tools to enhance clinician awareness, increase routine testing, and ensure appropriate care for individuals living with CKD. 

As a part of a Collective Impact strategy to increase CKD testing and identification in Missouri, NKF partnered with University Health (UH), a safety-net academic health system in Kansas City, MO to employ the CKD Learning Collaborative, a systems change approach to improve clinician awareness of CKD, improve routine testing for CKD, and ensure that people with laboratory evidence of CKD are appropriately risk stratified and receiving guideline concordant care. With its mission of providing compassionate care to all regardless of insurance status, UH expressed interest in implementing the Learning Collaborative as a follow up project to the implementation of the CKD-EPI 2021 Race Free eGFR equation. 

Using NKF’s Data Analysis Strategy, UH evaluated its electronic health record (EHR) data to assess the burden of CKD within their at-risk population. The data analysis helps partners identify gaps in testing and diagnosis, from there, partners are able to develop a strategy and measurable goals for gap closure. A multidisciplinary team of leaders at NKF and UH worked together to implement CKD-specific clinical decision support tools and standardized referral pathways between nephrology and primary care for effective co-management. As a part of the intervention UH was able to integrate education into existing platforms, including waiting room monitors, discharge paperwork, and monthly email segments. UH took a bottom-up approach to physician education and leveraged the role and energy of medical students and residents. UH nephrologists, with other physician champions, were able to hold lectures with the residents, who in turn were able to broadly promote the interventions with patients and other faculty physicians. 

Across three clinics, 65 clinicians and primary care team members participated in recurring meetings for CKD education, workflow redesign, and care coordination planning.

Quarterly data reviews helped benchmark each clinic’s performance. Regular clinic meetings enabled reflection and workflow enhancements which resulted in an over 60% improvement in guideline concordant testing among the populations at-risk for CKD and over 25% improvement in appropriate CKD diagnosis. 

The collaboration fostered a culture of learning at the health system that extended from educating patients on CKD to training the next generation of providers at the health system. UH was able to leverage NKF’s facilitation and expertise in process improvement to build capacity and support improvements in care of the most vulnerable populations in the Kansas City community. Upon interest and staff capacity, University Health hopes to expand the model across additional primary care clinics and partner with NKF on a pilot program to support patients newly diagnosed with early-stage CKD. Since this launch, three additional Missouri health systems have implemented the model, with another health system on the horizon. NKF’s Population Health team is ready to support organizations nationwide in replicating this impact.