Abstract
Advancing Nephrology Care Access for Veterans: Implementation and Insights from a Telenephrology Program: SA-PO1076
Journal of the American Society of Nephrology, Vol.35(10S)
10/2024
DOI: 10.1681/ASN.2024kykz41v6
Abstract
Background:
Chronic kidney disease (CKD) is a significant health concern among Veterans, often compounded by delayed nephrology referrals. A Telenephrology program was introduced at the Iowa City Veterans Affairs Health Care System (ICVA) in 2018. A dashboard alerted the nephrology service when CKD or acute kidney injury were noted prompting either an e-consult or an outpatient consult to the nephrology service. Here, we evaluated the impact of the program on nephrology encounters.
Methods:
We conducted a retrospective cohort study involving Veterans receiving care in Veterans Integrated Service Network (VISN) 23, which consists of 8 medical centers and affiliated clinics. The cohort included patients with at least one eGFR <60 during from 2014 to 2016. Patients with nephrology encounters before 2014 or who died before 2016 were excluded. Annual outpatient virtual and face to face nephrology encounters from 2016 to 2020 were identified. Poisson regression was used to compare nephrology encounters per months alive before and after the intervention to other VISN 23 sites during the same time period, controlling for patient characteristics.
Results:
We identified 5161 eligible patients in Iowa City and 44618 in other VISN 23 sites. Veterans in ICVA were older with higher rates of heart failure, peripheral vascular disease, and hypertension. Nephrology encounters rose by ~78% and 114% during 2018-2019 and 2019-2020 compared to the average annual encounters during 2016-2018 [Rate ratios were 1.78 (95% CI, 1.62-1.95; p<.001) and 2.14 (95% CI, 1.97-2.32; p<.001)]. Compared to other sites in VISN23, nephrology encounters per month increased to a lesser extent in ICVA. In the period March 2018-February 2019, the increase in encounters in ICVA was 86% of that observed in other VISN 23 sites (relative rate = 0.86; 95% CI, 0.79-0.95; p<.001). During 2019-2020, the rate of increase in Iowa City was 85% of the increase observed in other VISN 23 sites (relative rate = 0.85; 95% CI, 0.78-0.93; p<.001).
Conclusion:
The Telenephrology program in Iowa City improved access to nephrology care but the annual increase in virtual and face-to-face encounters was smaller than seen in other VISN23 facilities. Future studies will explore the impact of the Telenephrology program on clinical outcomes.
Details
- Title: Subtitle
- Advancing Nephrology Care Access for Veterans: Implementation and Insights from a Telenephrology Program: SA-PO1076
- Creators
- Melissa L. Swee - University of IowaMary Vaughan Sarrazin - University of Iowa, General Internal MedicineM. Lee Sanders - University of IowaHeather Reisinger - University of IowaKantima Phisitkul - Iowa City VA Medical CenterAngie R. Thumann - Iowa City VA Medical CenterBradley S. Dixon - Iowa City VA Medical CenterDiana I. Jalal - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of the American Society of Nephrology, Vol.35(10S)
- Publisher
- AMER SOC NEPHROLOGY
- DOI
- 10.1681/ASN.2024kykz41v6
- ISSN
- 1046-6673
- eISSN
- 1533-3450
- Grant note
- NIDDK
NIDDK Support, Private Foundation Support
- Language
- English
- Date published
- 10/2024
- Academic Unit
- Center for Social Science Innovation; General Internal Medicine; Internal Medicine; Nephrology; Health Management and Policy
- Record Identifier
- 9984738878502771
Metrics
12 Record Views