Digital infrastructure assists patients who need kidney replacement treatments
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Digital engagement tools effectively identified patients who needed shared and informed decision-making and helped prepare those who required kidney replacement treatments, according to results of a mixed methods study.
“By helping health care providers identify patients who are most in need of preparation early, helping patients clarify their values, prompting patients’ informed decision-making, tracking patients’ preparation for treatments and supporting their navigation toward preferred therapies, the infrastructure may play an important role in supporting efforts to overcome patients’ barriers to receiving their desired treatments,” Jamie A. Green, MD, of the department of nephrology at Geisinger Commonwealth School of Medicine and Geisinger’s Kidney Health Research Institute, and colleagues wrote.
Recognizing a void in available digital health systems targeted to kidney failure treatments, Green and colleagues developed a suite of digital engagement tools, Prepare Now, which they implemented in a small subgroup of early study participants in their 4-year cluster, randomized, controlled clinical trial in eight nephrology clinics at Geisinger. The digital intervention included a chronic kidney disease registry, tracking application, problem list documentation and values tool. Researchers evaluated four of the eight clinics on implementation of Prepare Now during the first year. Two kidney transition specialists were included to ascertain patients’ reactions to Prepare Now, as well as its ease of use.
Between July 1, 2017 and June 30, 2018, Green and colleagues found 1,032 patients met the Prepare Now criteria for kidney failure in the four Geisinger clinics. By 12 months, the training specialists enrolled 117 high-risk patients into the Prepare Now program.
Of the patients who attended a kidney modality education session, 91% completed the values tool. Nurse case managers used the tracking application for all patients to document 287 planning steps for kidney replacement therapy. In addition, 87% of high-risk patients recorded their preferred kidney replacement modality, with most preferring in-center hemodialysis across all potential options (37%). The case managers reported that the Prepare Now tools assisted in identifying patients who required support.
“[T]he Prepare Now Study has demonstrated the successful implementation and uptake of an integrated suite of digital tools providing the health system infrastructure to support a number of key functions to facilitate patients’ shared and informed decision-making and preparation for kidney failure treatments,” Green and colleagues wrote. “This supportive health system infrastructure could have a significant impact on the clinical care of patients with CKD and their outcomes.”
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