Dr Joseph Vassalotti Presents Findings of AJMC® Study on CKD Intervention

A study published in the November issue of The American Journal of Managed Care® (AJMC®) provides evidence from an intervention for chronic kidney disease (CKD), explained lead author Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.
What were the findings of your recent AJMC® study on a health plan’s CKD intervention?
The study showed a population health, simple, scalable intervention for chronic kidney disease among people with diabetes and/or hypertension, showed reduction in hospitalizations and readmission and selected cost containment. So we’re really excited that this short-term 2-year study with a pre- and post design showed benefits in chronic kidney disease population health intervention.

Which aspects of the intervention do you think had the greatest effect on outcomes?
The study was designed to incorporate both the blood and urine testing for kidney disease, the estimated GFR [glomerular filtration rate] and the urine albumin-to-creatinine ratio tests, so those are tests of kidney function and kidney damage, and by defining kidney disease according to those tests and stratifying the risk at 5 different levels, we were able to employ a population health that was scaled to the severity of disease in a patient-centered medical home with CareFirst Blue Cross Blue Shield in Maryland.

Why was the intervention successful? So certainly the risk stratification informing the interventions is probably the most important aspect of the study to emphasize. It wasn’t just the kidney function, it was the kidney function by the estimated GFR with the urine albumin-to-creatinine ratio together, and a layered intervention that increased as the severity of the disease increased. The other important aspect of the study was that we did increase the use of medical nutrition therapy for the patients with chronic kidney disease, which is impactful.

And then we allocated the nephrology services in a way that was more consistent with the heat map class, or the severity of the disease. For example, the patients with class 5 on the heat map which are the most severe at risk for adverse events, in the preintervention year, 63% of the patients saw a nephrologist, and the ones that saw a nephrologist saw a nephrologist quarterly. In the postintervention year, 83% of the patients with CKD class 5 saw a nephrologist, and they saw a nephrologist, on average, monthly. So we had intensification of nephrology services for the patients with the most advanced disease, and we didn’t have any increase in nephrology services for patients with lower classes or lower severity of CKD. So, we allocated a finite resource, nephrology services, according to the risk stratification.
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