title: Going Upstream: Coordination to Improve CKD Care.
abstract: Care coordination for patients with chronic kidney disease has been shown to be effective in improving outcomes and reducing costs. However, few patients with CKD benefit from this systematic management of their kidney disease and other medical conditions. As a result, outcomes for patients with kidney disease are not optimal, and their cost of care is increased. For those patients who transition to kidney failure treatment in the United States, the transition does not go as well as it could. The effectiveness of treatments to delay progression of kidney disease in contemporary clinical practice does not match the efficacy of these treatments in clinical trials. Conservative care for kidney disease, which should be an option for patients who are very old and very sick, is not considered often enough or seriously enough. Opportunities for early and even pre-emptive transplantation are missed, as are opportunities for home dialysis. The process of dialysis access creation is rarely optimal. The consequence is care which is not as good as it could be, and much more expensive than it should be. We describe our initial efforts to implement care coordination for chronic kidney disease in routine clinical care and attempt to project some of the benefits to patients and the cost savings.
authors.affiliation: Dialysis Clinic, Inc., Nashville, Tennessee.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Johnson
authors.affiliation: Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.|Dialysis Clinic, Inc., North Brunswick, New Jersey.
authors.forename: Toros
authors.initials: T
authors.lastname: Kapoian
authors.affiliation: Dialysis Clinic, Inc., Nashville, Tennessee.|Nephrology Associates, Nashville, Tennessee.
authors.forename: Robert
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Klemens B
authors.initials: KB
authors.lastname: Meyer
mesh_terms: D000072700:Conservative Treatment; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards*; D018450:Disease Progression; D006801:Humans; D016030:Kidney Transplantation; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000191:economics / Q000628:therapy*