Abstract
BackgroundKidney disease accounts for more than 49 billion dollars in healthcare expenditures annually. Early detection and intervention may reduce the burden of disease. We describe a quality improvement project to develop a telenephrology dashboard that proactively monitors kidney disease.MethodsOne hundred eighty-four thousands Veterans within the Iowa City Veterans Affairs Health Care System were eligible for telenephrology consultation. The dashboard accessed the charts of 53,085 Veterans at risk for kidney disease. We utilized Lean-Six Sigma tools and principles and the Define-Measure-Analyze-Improve-Control Framework to develop and deploy a telenephrology dashboard in 4 community-based outpatient clinics (CBOCs). The primary measure was the number of days to complete consultation. Secondary measures included number of electronic consultations per month, distance and cost of Veteran travel saved, and number of steps for completion of consult.ResultsThe data of 1384 Veterans at the 4 CBOCs were analyzed by the telenephrology dashboard, of which 459 generated telenephrology consults. The number of days to complete any type of consultation was unchanged (48.9 days in 2019, compared to 41.6 days in 2017). The average Veteran saved between $21.60 to $63.90 per trip to Iowa City. Between March 2019 and August 2019, there were 27.3 telenephrology consults per month. The number of steps needed to complete the consult request was decreased from 13 to 9.ConclusionsUtilization of the telenephrology dashboard system contributed to an increase in consultations completed through electronic means without decreasing face-to-face consults. Electronic consults now outnumber traditional face-to-face consultations at our institution. Telenephrology consultation improved early detection and identification of kidney disease and saved time and costs for Veterans in travel, but did not decrease the average number of days to complete consultation requests.
Highlights
Kidney disease accounts for more than 49 billion dollars in healthcare expenditures annually
Lean Six Sigma is a well-validated set of methods to systematically engage in quality improvement, and the DMAI C Framework has been utilized in multiple healthcare settings to effect successful changes in practice [10, 11]
This quality improvement project helps to address this challenge through the creation of a dashboard for telenephrology consultation
Summary
Kidney disease accounts for more than 49 billion dollars in healthcare expenditures annually. Detection and intervention may reduce the burden of disease. We describe a quality improvement project to develop a telenephrology dashboard that proactively monitors kidney disease. Detection of at-risk patients in primary care clinics and timely consultation with kidney specialists may potentially reduce this burden [3]. The global nephrology workforce shortage further exacerbates the problem and highlights the need to develop newer tools to more efficiently evaluate and care for patients with early signs of kidney disease [5]. Because the practice of nephrology is largely dependent upon monitoring of laboratory results and vital signs, development of a dashboard for kidney diseases is an appealing quality improvement approach [8]
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