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Patient centered care

Kidney failure affects more than 115,000 U.S. adults every year. Patients who develop this condition must choose from a variety of treatments, such as dialysis or a kidney transplant, each of which has advantages and disadvantages that may vary depending on the individual. Unfortunately, kidney failure often occurs before patients are aware of the extent of their illness, forcing them to quickly make decisions with lifelong consequences without being fully prepared or able to make informed decisions. 


KHRI researchers are partnering with patients and a team of researchers at Duke and Johns Hopkins to measure the effectiveness of a new healthcare delivery process to improve the care of patients with advanced kidney disease. The PREPARE NOW study will employ a new care strategy to help patients understand their risks of kidney failure, understand their treatment options, obtain needed support and choose treatments that are aligned with their personal values. In a randomized controlled trial, researchers will measure the effectiveness on the new care strategy on patients’ outcomes.


An estimated 26 million adults in the United States have chronic kidney disease (CKD). Patients with CKD can progress to end-stage renal disease (ESRD) and are also at high risk for cardiovascular disease and increased mortality. Despite the fact that patients with CKD and ESRD represent only about 1% of the total Medicare population, their care accounts for nearly 10% of annual Medicare expenditures. Earlier diagnosis and treatment of CKD can slow disease progression and significantly reduce healthcare costs.

The majority of patients with CKD are managed solely by primary care physicians (PCPs), yet primary care adherence to clinical practice guidelines remains suboptimal. Major barriers to providing optimal care to patients with CKD include poor recognition of patients with CKD and lack of awareness to treatment guidelines. Electronic-health record (EHR) – based reminders and clinical decision support (CDS) have been identified as potential tools to improve the identification of CKD, facilitate monitoring, and improve adherence to treatment targets, however, studies of the use of CDS tools to improve CKD management of primary care have been mixed.

At Geisinger, nearly 15,000 patients with CKD are managed by primary care alone. The Nephrology Department has been an innovator in facilitating the primary care management of CKD through a variety of clinical decision support tools. Despite this, performance measures of primary care management of CKD remain suboptimal. Potential reasons for this include lack of awareness of CDS tools, “alert fatigue”, or confusion about CKD guidelines. We aim to better understand barriers and facilitator to primary care management of CKD at Geisinger to guide the implementation of a quality improvement program. This suggests that additional resources and support are needed to improve primary care management of CKD beyond CDS alone.

The National Kidney Foundation (NKF) recently developed CKDinform: Early Detection and Prevention to improve CKD diagnosis and create a culture of kidney preservation and protection in busy primary care settings. This program provides education and a collection of evidence based tools and protocols to significantly enhance CKD detection and treatment. These protocols can be immediately applied to practice, allowing PCPs to quickly improve CKD patient safety and reduce CKD-related adverse events. 

Through a relationship with the NKF, we aim to implement their CKDinform program within Geisinger community practice service line (CPSL) sites. We propose to enhance current CDS tools with the CKDinform program to improve provider confidence in CKD management, improve CKD quality metrics, reduce disease progression, support timely and appropriate referrals to nephrology, and ultimately reduce healthcare costs.

Related publications

Putting patients at the center of kidney care transitions - PrepareNow

Patient Education and Support During CKD Transitions: When the Possible Becomes Probable.

Green JA and Boulware LE.  
Advances in Chronic Kidney Disease. Jul;23(4):231-9.