Subject Matter Experts Research Articles

Exploration of polytomous-attribute Q-matrix validation in cognitive diagnostic assessment

Compared with typical binary attributes, polytomous attributes can take three or more values (corresponding to different levels of mastery of a respondent or measurement of an item). They can indicate whether a respondent possesses the attributes of interest and mastery levels. Therefore, the test with polytomous-attribute Q-matrix can become more informative and provide respondents with richer diagnostic information than the test based on the dichotomous-attribute Q-matrix. This paper extends the S-statistic and the residual method applicable for the Q-matrix of binary attributes to validate the polytomous-attribute Q-matrix. Under two common scenarios in real-world applications, two associated validation algorithms: the joint validation (JV) algorithm and the online validation (OV) algorithm, are proposed. Both simulation studies and an empirical data example were employed to assess the robustness and usefulness of these two methods under various conditions. Results indicate that the JV algorithm is suitable for validating a Q-matrix predefined by subject matter experts. Especially when the Q-matrix contains fewer misspecifications, while the OV algorithm can be applied to define the attribute vector of "new items". Based on a certain number of "operational items", the OV algorithm can achieve a promising performance for obtaining the specification of the new items.

Using Q-methodology to discover disaster resilience perspectives from local residents

Finding ways to increase local community resilience is important, therefore, this study explores how to use individual disaster resilience indicators and provides new ways to quantify them. Specifically, Q-methodology is used as a combined approach of qualitative and quantitative techniques to examine the shared perspectives among the residents in the Dove Springs community of Austin, Texas. To maintain adaptability and eliminate repetition and ambiguity, the initially retrieved set of 95 indicators was reduced down to 45 through two cycles of revision with subject matter experts. A total of 41 respondents were engaged in our study, and they prioritized the indicators based on their understanding of community well-being. Participants also identified their perspective of the two most important and unimportant statements. As a result, four types of perspectives were identified as informing the status of resilience: housing and food security, education and employment, equity, and disaster preparedness. Subsequently, we proposed a weighted quantification strategy to derive a single resilience value within a hierarchy from indicator level through category level. The findings and suggestions from our mixed-method study lay the groundwork for a better quantitative assessment of disaster resilience in a local context that can be beneficial for decision-making.

Efektivitas Ensiklopedia sebagai Suplemen Bahan Ajar Digital pada Muatan PPKn Materi Keberagaman Budaya Bangsa Indonesia Kelas V SD Negeri 18 Pontianak Utara

This research aims to determine the effectiveness of an encyclopedia to make students more interested, enthusiastic, less prone to boredom, and facilitate their understanding of the material presented through this instructional material. The study employs a descriptive research design with a qualitative approach. The participants in this study are all fifth-grade students of class V B, totaling 33 individuals. Qualitative data are obtained from interviews conducted by the researcher with selected students based on predefined categories. The validity of the instructional material design has been validated by media and subject matter experts, receiving an excellent category for use but still requiring revision before being tested. The data collection techniques in this study include interviews and questionnaires. The data collection instrument used in this research is a test to measure students' abilities in the effectiveness of the encyclopedia as a supplementary digital instructional material. The results obtained in this study show that students' responses fall into the very positive category, indicating that it is highly suitable for use with audiovisual displays in the PPKn (Civics Education) learning content on the cultural diversity of the Indonesian nation. It received very positive responses from students, and the learning outcomes obtained by the students were good, as seen in the evaluation test results. The encyclopedia significantly helps students understand this material, and its flexible use further facilitates students' learning at home. Considering the responses and learning outcomes of the students, the effectiveness of the encyclopedia as a supplementary digital instructional material makes it easier for teachers and students to revisit the content of the cultural diversity of the Indonesian nation.

Adapting the Gamified Educational Networking Online Learning Management System to Test a Decentralized Simulation-Based Education Model to Instruct Paramedics-in-Training on the Emergency Intraosseous Access and Infusion Skill.

Intraosseous (IO) access and infusion is a safe and rapid alternative to intravenous access in obtaining vascular access for administering fluids and drugs. Healthcare professionals, such as primary and advanced care paramedics, use IO access and infusion in emergency circumstances where peripheral intravenous routes are inaccessible. IO access skills require hands-on training, which can be done remotely if the participants have access to simulation, instructions, guidance, and feedback. For the purpose of moving the training outside of the simulation laboratories, we have developed (1) an inexpensive and scalable three-dimensional (3D) printed and silicone-based advanced adult proximal tibial IO access and infusion simulator and (2) a unique learning management system (LMS) for remote simulation-based training. The LMS was built using the Django platform and supports experiential learning by providing access to educational and instructional content (including virtual simulation and serious games), allowing peers to communicate among themselves and with subject-matter experts, provide and receive feedback asynchronously, and engage in learning using gamification elements. The aim of this technical report is to describe the process of development and the final product of the LMS as a research and educational tool to scaffold remote learning of emergency IO skills by paramedics-in-training.

Vaccine value profile for Klebsiella pneumoniae

Klebsiella pneumoniae causes community- and healthcare-associated infections in children and adults. Globally in 2019, an estimated 1.27 million (95% Uncertainty Interval [UI]: 0.91–1.71) and 4.95 million (95% UI: 3.62–6.57) deaths were attributed to and associated with bacterial antimicrobial resistance (AMR), respectively. K. pneumoniae was the second leading pathogen in deaths attributed to AMR resistant bacteria. Furthermore, the rise of antimicrobial resistance in both community- and hospital-acquired infections is a concern for neonates and infants who are at high risk for invasive bacterial disease. There is a limited antibiotic pipeline for new antibiotics to treat multidrug resistant infections, and vaccines targeted against K. pneumoniae are considered to be of priority by the World Health Organization. Vaccination of pregnant women against K. pneumoniae could reduce the risk of invasive K.pneumoniae disease in their young offspring. In addition, vulnerable children, adolescents and adult populations at risk of K. pneumoniae disease with underlying diseases such as immunosuppression from underlying hematologic malignancy, chemotherapy, patients undergoing abdominal and/or urinary surgical procedures, or prolonged intensive care management are also potential target groups for a K. pneumoniae vaccine.A ‘Vaccine Value Profile’ (VVP) for K.pneumoniae, which contemplates vaccination of pregnant women to protect their babies from birth through to at least three months of age and other high-risk populations, provides a high-level, holistic assessment of the available information to inform the potential public health, economic and societal value of a pipeline of K. pneumoniae vaccines and other preventatives and therapeutics. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public–private partnerships, and multi-lateral organizations, and in collaboration with stakeholders from the WHO. All contributors have extensive expertise on various elements of the K.pneumoniae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.

Improving Professional Development Based on Evaluation of Nursing Education Programs Through Feedback.

A feedback-driven selection process to evaluate professionals strengthens and improves the quality of future education they provide. A university in Sri Lanka invited teaching specialists by incorporating feedback of those teaching educators. The selection of professionals to teach courses improved the quality of education drastically. The findings show that refining education through feedback enhances future education quality and promotes subject matter expert engagement in improving educational programs. [J Contin Educ Nurs. 2024;55(3):110-112.].

Risk First Mindset in “Security First vs Compliance First” Debate

The idea of Security first vs compliance first approach has been plaguing the Cybersecurity industry and others, for a while now, Subject matter experts on both sides of the aisle have been debating and trying to make their point heard across the other side, explaining why is it that a certain approach is better than the other!. All of these points are valid and backed with facts and use cases.

Rapid risk assessment of plant pathogenic bacteria and protists likely to threaten agriculture, biodiversity and forestry in Zambia

A prioritisation study was conducted to address the lack of adequate information about potential pests likely to be introduced in Zambia and become invasive. The study was conducted by subject matter experts from relevant institutions in and outside Zambia. Although this study focused on major pest categories, this paper only addresses bacteria and Protista. A list of 306 bacterial and 10 Protista species adjudged to affect plants was generated using CABI’s Horizon Scanning Tool. The 316 (total) pest species were refined to focus on pests that affect value chains important to Zambia’s economy. This resulted in a final list of 133 bacteria and eight Protista. Four additional bacteria species considered of phytosanitary interest were added and all 137 bacteria and eight Protista species were subjected to a rapid risk assessment using agreed guidelines. Vectors reported to transmit any of the pathogenic organisms were also subjected to a risk assessment. A proportion of 53% (n = 77 of 145) comprising 73 bacteria and four Protista species were reported as present in Africa. Of these, 42 (57%, n = 73) bacterial species and two (n=4) Protista species were reported in neighbouring countries. Considering a cut-off of 54, the highest scoring pests were 40 bacteria (highest score of 140) and three Protista (highest score of 125). Three actions were suggested for high-scoring pests, a detection surveillance, a pest-initiated pest risk analysis (PRA) or a detection surveillance followed by pest-initiated PRA. A “no action” was suggested where the risk was very low although, for some pathogenic organisms, a “no action” was followed by periodic monitoring. This information will contribute towards proactive prevention and management of biological invasions.

What Do You Need? Information Requirements and Task Analysis of (Future) Advanced Air Mobility Pilots in the Emergency Medical Service

In the domain of Advanced Air Mobility (AAM), Simplified Vehicle Operations (SVOs) promise a reduction in handling complexity and training time for pilots. Designing a usable human–machine interface (HMI) for pilots of SVO-enabled aircraft requires a deep understanding of task and user requirements. This paper describes the results of two user research methods to gather these requirements. First, a traditional Helicopter Emergency Medical Service (HEMS) mission was examined using a Hierarchical Task Analysis (HTA). The findings were used to formulate a theoretical HTA for a single-piloted electric Vertical Take-Off and Landing (eVTOL) system in such a scenario. In the second step, qualitative interviews with seven subject matter experts (pilots and paramedic support) in HEMS operations produced vital user requirements for HMI development. Key findings emphasize the necessity of a simplified information presentation and collision avoidance support in the HMI.

Hybrid Android Interface Practicum Mode to Develop Students' Science Process Skills

Science Process Skills are abilities that students must possess because they are applicable not only to science learning but also to daily life. To be familiar with scientific method activities, students must have direct experience in order to be trained in Science Process Skills. This study aims to enhance students' Science Process Skills through hybrid android interface mode practicum learning. The research data was collected using description questions previously validated by subject matter experts. This study conducted quasi-experiments using the Nonquivalent (pretest-posttest) Control Group Design method. The research participants included control and experimental groups. The research results show an increase in Science Process Skills in the experiment class as evidenced by the achievement of aspects of observation 71.25%, interpretation 78.25%, classification 86.12%, prediction 84.45%, conducting experiments or investigations 83.34%, communicating 63.33%, hypothesizing 79.63%, applying concepts 88.34%, and asking questions 82.43%. It shows that the practicum mode of the hybrid Android interface can develop Science Process Skills

Lessons Learned From State-Based Efforts to Leverage Medicaid Funds for Graduate Medical Education.

Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have flexibility in designing Medicaid GME payments to address population health needs. This study assessed states' impetus for using Medicaid funds for GME, structure of state Medicaid payments, composition and charge of advisory bodies that guide these investments, and degree of transparency and accountability to track whether Medicaid GME investments achieved desired workforce outcomes. Structured interviews were conducted in 2015 to 2016 and 2020 to 2021 with subject matter experts representing 10 states. Interview transcripts were analyzed and coded in 6 thematic areas: impetus for using Medicaid funds, the structure of state Medicaid payments, the composition of advisory bodies, the degree of transparency of Medicaid investments, accountability of Medicaid investments, and challenges and changes. States used Medicaid GME funding to address maldistribution of physicians by geography, setting, and specialty, respond to population growth and undergraduate medical education expansion, offset potential loss of teaching health center program funds, and launch new programs and sustain existing ones. States leveraged Medicaid funding by modifying state plan amendments and redesigning funding formulas to meet specific health workforce needs. Many states had advisory bodies to educate legislators, reach consensus on workforce needs, recommend how to disburse funds, and navigate competing stakeholder interests. States identified a need for improved data and analytic systems to understand workforce needs and monitor the outcomes of GME investments. Determining which accountability measures to use and implementing metrics were challenges. States have much to learn from each other about strategies to best leverage Medicaid funds to develop and sustain residency programs to meet population health needs. Learning collaboratives should be developed to provide a forum for states to share best practices and strategies for overcoming challenges.

Earthquake Disaster Preparedness Profile Among Students in Bantul

The purpose of this study is to evaluate the level of preparedness of students in facing earthquake disasters in three schools in Bambanglipuro and to provide recommendations for improving student preparedness. This study utilized a quantitative descriptive method involving 124 students as research samples. The research instrument used was an open-ended questionnaire that had been validated by subject matter experts and language experts. The questionnaire consisted of 17 items taken from four parameters of preparedness: attitude (6 items), emergency response planning (5 items), disaster warning systems (1 item), and social mobilization (4 items). The data obtained were analyzed using ANOVA to determine the differences among the three junior high schools. Based on the research findings, it was found that overall, the three schools had similar levels of preparedness, with SMPN 2 Bambanglipuro being classified as "ready" at 80%, while SMP Muh Bambanglipuro and SMPN 1 Bambanglipuro were classified as "almost ready" at 79%. However, there were some parameters of preparedness where the students in all three schools were classified as "almost ready" or "ready," except for the attitude parameter in SMPN 2 Bambanglipuro, which was categorized as "low" at 53%.

A Participatory Approach to Identifying Gaps in and Recommendations for Sexually Transmitted Infection and Preexposure Prophylaxis Clinical Services in Pierce County, Washington.

Pierce County, Washington, has a high burden of sexually transmitted infections (STIs) relative to Washington State and the United States. We used a participatory approach to identify gaps in STI and preexposure prophylaxis (PrEP) service provision in Pierce County and generate recommendations to address these gaps. In collaboration with the Tacoma-Pierce County Health Department (TPCHD), we conducted 14 key informant interviews with local STI/PrEP providers from varied clinical settings. Using rapid qualitative analysis, we identified key gaps and strengths in service provision. Local, state, and national HIV/STI subject matter experts (SMEs) prioritized the gaps and recommendations to address them via an online survey. The primary 6 gaps ranked by SMEs (N = 32) in order of importance included the following: (1) inadequate availability of STI and PrEP services, (2) lack of awareness of STI and PrEP services, (3) need for free/low cost STI and PrEP care, (4) need for stronger relationships among providers and TPCHD, (5) reduced accessibility related to geographically distributed population and centralized services, and (6) frequent referrals pose a service barrier. Subject matter experts prioritized recommendations for each gap as follows: (1) create an STI specialty clinic, (2) implement an STI/PrEP service availability outreach campaign, (3) strengthen referral relationships between TPCHD and free/low-cost providers, (4) develop a provider support network, (5) create a mobile STI clinic, and (6) develop an STI specialty clinic. Sexually transmitted infection specialty clinics were prioritized by SMEs to improve access to STI and PrEP care in Pierce County, and to serve as a resource for local providers.

Development of Reciprocal Teaching-Based Interactive Multimedia to Enhance Students' Learning Outcomes of Database Fundamentals

Database subjects are one of the basic compulsory subjects for the Computer Engineering and Informatics program. For Software Engineering students, topics such as Data Definition Language (DDL) and Data Manipulation Language (DML) are crucial for understanding advanced lessons. However, learning outcomes have been low due to factors such as suboptimal media, methods, models, and teaching processes. This research aims to design reciprocal teaching-based interactive multimedia to enhance student learning outcomes in DDL and DML materials. The research method used is adapted from the Comprehensive Life Cycle model, with a sample of students from class X-RPL-1 at Bina Wisata Lembang Vocational High School.The results of this study are as follows: 1) An average percentage of 80% was obtained from media experts and 80% from subject matter experts, both categorized as “Very Good”. 2) The use of multimedia improved student learning outcomes, demonstrated by an average score increase from 34 to 73. Furthermore, based on the pretest and posttest results, an average normalized gain (n-gain) of 0.59 was obtained with a criteria of 'Moderate' effectiveness. 3) Students responses to the created multimedia resulted in an average percentage score of 86.41%, categorized as “Very Good”.

Why Violence Cannot be Prevented in Healthcare Settings in Türkiye?: A Retrospective Policy Analysis.

Preventive policies have been devised with the aim of curbing health-related violence, and their efficacy is believed to furnish evidence for their continued implementation, thereby enhancing their effectiveness. This study undertakes a retrospective analysis of these policies in the context of Türkiye. A comprehensive examination involved the review of 26 documents, employing a progressive scanning approach for data collection. This methodology encompassed the utilization of gray literature databases (OECD iLibrary and WHO Iris), extensive Google searches, thorough website scans, and consultations with subject-matter experts. Data analysis was meticulously conducted within the framework of the Health Policy Triangle. The findings reveal active participation from diverse stakeholders, including governmental bodies, political entities, professional organizations, and trade unions, in various preventive initiatives aimed at mitigating health-related violence. Notably, the adoption of legislation for health violence prevention, perceived as a paramount achievement, can be attributed to persistent efforts by both the media and other influential actors and stakeholders. These endeavors have sustained the topic's prominence on the policy agenda, positioning it as a promising source for the development of novel violence prevention and management strategies. This study underscores the necessity for a comprehensive investigation into the working conditions, personal rights, and wage policies of healthcare workers, in light of documented factors that frequently precipitate violence. Concomitantly, it advocates for the development of effective mechanisms to address these issues.

The ultra-short version of the Burnout Assessment Tool (BAT4)-development, validation, and measurement invariance across countries, age and gender.

Given that burnout is a major problem in many societies and that employers are legally obliged to act in preventing job stress, there is a need of validated and reliable short self-report instruments. The Burnout Assessment Tool (BAT) is developed to measure burnout as a syndrome with four core components (exhaustion, mental distance, cognitive and emotional impairment). So far, the BAT was tested in over 40 studies with encouraging results. Although a short, 12-item version of the BAT exists, there is need for an ultra-short version with even less items. The overall aim is to develop an ultra-short 4-item version of the BAT (BAT4) and to evaluate its construct validity using Rasch analysis in samples from various countries along with its measurement invariance regarding country, age and gender. The BAT4 was developed using mixed methods, i.e. combining the results from a Rasch analysis, a subject matter analysis and expert judgements. Construct validity was tested on data from national representative samples from eight countries (the Netherlands, Belgium (Flanders), Austria, Czech Republic, Finland, Germany, Ireland, and Japan) and in a pooled sample combing the data from all eight countries. Differential item functioning regarding age, gender and country was investigated. The BAT4 fulfilled all the criteria required by the Rasch measurement model to constitute a valid measure in the pooled and country specific samples, except Austria and Japan. In the pooled sample, measurement invariance between the eight countries as well as between gender and age was found. Analyses within different countries showed occasional gender and age DIF for some items. The results were promising regarding BAT4's construct validity and measurement invariance. Although the BAT4 includes only four items, its content coverage is acceptable. The BAT4 can be used as a short screening instrument for burnout complaints at the group or organisational level.

Development of Competency Manual for the Philippine Coast Guard (PCG) Commanding Officers

The study emphasized the importance for effective leadership in the Philippine Coast Guard (PCG) and introduces the development of a specialized Competency Manual tailored for PCG Commanding Officers, guided by the Dreyfus model of skills acquisition. While effective leadership is vital for maritime safety and security, the absence of a structured competency framework poses challenges for PCG Commanding Officers, impeding their adaptability and effectiveness in rapidly evolving maritime environment. The development process encompassed a thorough needs assessment, which included reviewing PCG regulations, competency frameworks, and conducting a comprehensive analysis of the Dreyfus model. Collaborative efforts with subject matter experts, surveys, and pilot testing involving PCG officers played a pivotal role in refining the content of the manual. The result of the study yields a Competency Manual that meticulously defines specific competencies, knowledge, skills, and behaviors deemed essential at each stage of the Dreyfus model. Covering critical areas such as maritime regulations, navigation, decision-making, leadership, and crisis management, the manual precisely caters to the unique demands placed on PCG Commanding Officers. The Competency Manual stands out as a structured and progressive tool for skill development, ensuring that PCG Commanding Officers are well-prepared to navigate the difficult challenges inherent in their roles. Effective implementation that entails the seamless integration of the manual into PCG's training programs, conducting routine assessments, and establishing channels for continuous improvement. This strategic approach seeks to foster the development of PCG Commanding Officers into highly proficient leaders, empowering them to adeptly protect maritime interests in the Philippines.

Practical wisdom in the workplace: conceptualization, instrument development, and predictive power

Purpose The purpose of this Real Impact Research Article is to empirically explore one of the most controversial and elusive concepts in knowledge management research – practical wisdom. It develops a 10-dimensional practical wisdom construct and tests it within the nomological network of counterproductive and productive knowledge behavior. Design/methodology/approach A survey instrument was created based on the extant literature. A model was developed and tested by means of Partial Least Squares with data obtained from 200 experienced employees recruited from CloudResearch Connect crowdsourcing platform. Findings Practical wisdom is a multidimensional construct that may be operationalized and measured like other well-established knowledge management concepts. Practical wisdom guides employee counterproductive and productive knowledge behavior: it suppresses knowledge sabotage and knowledge hiding (whether general, evasive, playing dumb, rationalized or bullying) and promotes knowledge sharing. While all proposed dimensions contribute to employee practical wisdom, particularly salient are subject matter expertise, moral purpose in decision-making, self-reflection in the workplace and external reflection in the workplace. Unexpectedly, practical wisdom facilitates knowledge hoarding instead of reducing it. Practical implications Managers should realize that possessing practical wisdom is not limited to a group of select, high-level executives. Organizations may administer the practical wisdom questionnaire presented in this study to their workers to identify those who score the lowest, and invest in employee training programs that focus on the development of those attributes pertaining to the practical wisdom dimensions. Originality/value The concept of practical wisdom is a controversial topic that has both detractors and supporters. To the best of the author’s knowledge, this is the first large-scale empirical study of practical wisdom in the knowledge management domain.

Breaking down the enigma of out-of-field research teaching among private senior high schools in Davao City, Philippines: A transcendental phenomenological inquiry

Subject matter expertise goes far beyond simply knowing and regurgitating facts. It's a multifaceted ability encompassing a deep understanding of the content, pedagogical knowledge, assessment proficiency, fostering critical thinking and problem-solving skills, and cultivating positive attitudes and values. This transcendental phenomenological study was conducted to understand the lived experiences of SHS out-of-field research teachers in terms of assignment, instruction, and feedback. To grasp the phenomenon's essence, transcendental phenomenology aims to set aside the researcher's preconceived ideas and strive for neutrality. The study was participated by 14 teacher-participants from the selected private senior high schools in Davao City, Philippines. Findings show that in terms of assignment, participants' experiences include adherence and submission to school administrators, consideration of teacher potential, experience, and training, and feelings of anxiety and frustration. With regards to instructional experiences, it includes lack of experience, aptitude, and administrative support; difficulty in establishing authority and checking outputs. With those, participants must be resourceful and creative and engage in professional development activities. In terms of feedback, participants were honest and open-minded and experienced the welcoming nature of the students. The findings elaborate on the complex and multi-faceted nature of out-of-field teaching, which is expected to inspire improved teacher hiring and placement policy. It is recommended that educational institutions should provide professional development programs to help those out-of-field teachers stay updated with best practices.

Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review.

Approximately 37 million individuals in the United States (US) have chronic kidney disease (CKD). Patients with CKD have a substantial morbidity and mortality, which contributes to a huge economic burden to the healthcare system. A limited number of clinical pathways or defined workflows exist for CKD care delivery in the US, primarily due to a lower prioritization of CKD care within health systems compared with other areas (e.g., cardiovascular disease [CVD], cancer screening). CKD is a public health crisis and by the year 2040, CKD will become the fifth leading cause of years of life lost. It is therefore critical to address these challenges to improve outcomes in patients with CKD. The CKD Leaders Network conducted a virtual, 3 h, multidisciplinary roundtable discussion with eight subject-matter experts to better understand key factors impacting CKD care delivery and barriers across the US. A premeeting survey identified topics for discussion covering the screening, diagnosis, risk stratification, and management of CKD across the care continuum. Findings from this roundtable are summarized and presented herein. Universal challenges exist across health systems, including a lack of awareness amongst providers and patients, constrained care team bandwidth, inadequate financial incentives for early CKD identification, non-standardized diagnostic classification and triage processes, and non-centralized patient information. Proposed solutions include highlighting immediate and long-term financial implications linked with failure to identify and address at-risk individuals, identifying and managing early-stage CKD, enhancing efforts to support guideline-based education for providers and patients, and capitalizing on next-generation solutions. Payers and other industry stakeholders have opportunities to contribute to optimal CKD care delivery. Beyond addressing the inadequacies that currently exist, actionable tactics can be implemented into clinical practice to improve clinical outcomes in patients at risk for or diagnosed with CKD in the US.