title: Reducing CKD risks among vulnerable populations in primary care.
abstract: Ethnic/racial and socioeconomic status disparities in the health-care and clinical outcomes of patients with chronic kidney disease (CKD) are pervasive. The vast majority of care to decrease incidence of CKD risk and progression occurs in primary care settings. High-quality primary care, therefore, represents a key strategy through which disparities in the incidence and progression of CKD may be eliminated. The Chronic Care Model provides a framework for the delivery of high-quality primary care for chronic diseases, and it is frequently used to guide health-care quality improvement initiatives. Evidence suggests that Chronic Care Model constructs, including provider and organizational quality improvement initiatives focused on team approaches to chronic care (eg, case management, community health workers), are effective in modifying patients' CKD risks among ethnic minority and low-income patients. Other Chronic Care Model constructs, including clinical information systems (eg, disease registries), decision support interventions, and the provision of patient-centered care have been shown to improve processes related to CKD care but with limited and/or mixed effects on patient outcomes. Few studies have examined the effect of these approaches on reducing disparities. Research is needed to examine the effectiveness of these strategies to eliminate CKD disparities among vulnerable populations.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD; and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC. Electronic address: rfcharle@jhmi.edu.
authors.forename: Raquel
authors.initials: R
authors.lastname: Greer
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD; and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
mesh_terms: D018450:Disease Progression; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology; D006801:Humans; D015994:Incidence; D017146:Models, Organizational; D011314:Preventive Health Services / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D058996:Quality Improvement; D051436:Renal Insufficiency, Chronic / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations
keywords: Chronic kidney disease; Health-care disparities; Primary care; Quality improvement; Socioeconomic status