CKD and pre-ESRD Education Sessions
In January 2010, the renal community welcomed the enactment of the pre-ESRD Education Program with funding by the Centers for Medicare and Medicaid Services (CMS). This benefit permits qualified individuals to provide up to six educational sessions to Medicare eligible Stage IV CKD patients. CMS designated a “qualified person” to be a Physician, Nurse Practitioner, Physician Assistant, or an experienced Clinical Nurse Specialist. Funding is available for either individual or group sessions for the educational classes.
The curriculum for the pre-ESRD educational sessions is far reaching and includes an overview of CKD, management of CKD morbidities, vascular access, dialysis, transplant, etc., with an emphasis on treatment options and patient choice. The Center for CKD will offer these educational sessions utilizing the National Kidney Foundation’s, Kidney Learning Solutions entitled “Your Treatment, Your Choice” as the curriculum for these educational sessions. Interested CKD Stage IV patients who are Medicare beneficiaries should contact 216-444-6771.
Optimal Use of the Electronic Medical Record in CKD
The electronic medical record (EMR) has enabled creation of a CKD registry, a database that contains demographic information, critical parameters, and outcome measurements of more than 57,000 CKD patients who have received medical care within the Cleveland Clinic Health System since January 2005. Using EMRs, patients were identified using the following criteria:
- An estimated glomerular filtration rate (eGFR) below 60mL/min/1.73 m2 (measured in outpatients at least twice in an interval greater than three months), or
- An ICD-9 Diagnostic Code for kidney disease such as diabetic nephropathy, polycystic kidney disease, glomerulonephritis, and hypertensive nephrosclerosis. This database will be used to identify and enroll patients in clinical research projects.
Data elements within the CKD registry include:
- Patient demographics
- BP, height, weight, BMI
- Comprehensive laboratory testing, including GFR, anemia management, calcium, phosphorus, PTH, vitamin D, lipids, and other measures
- Medications
- Co-morbid diseases, especially cardiovascular disease and its risk factors.
Through EMRs, we now have a CKD registry containing over 57,000 patients.
The registry, which will interface with the U.S. Renal Data System (USRDS) and the Social Security network, is uniquely designed to track the management of CKD over the entire care spectrum, ranging from the primary care environment, traditional nephrologic care, CKD clinic, and renal replacement therapy with either dialysis or transplantation.
The registry will address the following in the scope of CKD management:
- Prevalence of CKD by stage within the Cleveland Clinic Health System.
- CKD recognition by physician and the health care team
- CKD progression with loss of GFR over time. The goal will be to produce a “CKD progression tool” for use by physicians, health care teams, and patients in preparing for future CKD needs such as education, vascular access, or renal replacement therapy including dialysis or renal transplantation.
- Assess “Processes of Care” by the physician regarding the ordering of appropriate assessment related to hypertension, anemia, hyperlipidemia, parathyroid hormone levels, and other parameters.
- Assess “Clinical Practice Measures Targets” related to the management of hypertension, anemia, hyperlipidemia, hyperparathyroidism, and other conditions.