title: Managing CKD by Telemedicine: The Zuni Telenephrology Clinic.
abstract: Telemedicine has significant potential to extend nephrology consultation to rural and isolated communities. We describe a telenephrology clinic that has delivered ongoing consultative care from a nephrologist based at the National Institutes of Health in Bethesda, MD, to the Zuni Comprehensive Health Center in western New Mexico. Over the past 9 years, the clinic has conducted 1870 patient visits managing patients using a collaborative approach engaging a nurse case manager, nephrologist, primary clinicians, pharmacists, and community health nurses. A significant proportion of the care provided is directed toward patients with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2). Although there are unique aspects to the Indian Health Service and to the Zuni community which is served by this clinic, this telemedicine clinic does serve as a demonstration that nephrologic consultative care can be delivered effectively and efficiently to rural high-risk communities using a collaborative and integrated model of care.
authors.affiliation: National Kidney Disease Education Program, National Institutes of Health, Bethesda, MD; Zuni Comprehensive Community Health Center, Indian Health Service, Zuni, New Mexico; and Center for Information Technology, National Institutes of Health, Bethesda, MD. Electronic address: narvaa@niddk.nih.gov.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Narva
authors.affiliation: National Kidney Disease Education Program, National Institutes of Health, Bethesda, MD; Zuni Comprehensive Community Health Center, Indian Health Service, Zuni, New Mexico; and Center for Information Technology, National Institutes of Health, Bethesda, MD.
authors.forename: Gayle
authors.initials: G
authors.lastname: Romancito
authors.affiliation: National Kidney Disease Education Program, National Institutes of Health, Bethesda, MD; Zuni Comprehensive Community Health Center, Indian Health Service, Zuni, New Mexico; and Center for Information Technology, National Institutes of Health, Bethesda, MD.
authors.forename: Thomas
authors.initials: T
authors.lastname: Faber
authors.affiliation: National Kidney Disease Education Program, National Institutes of Health, Bethesda, MD; Zuni Comprehensive Community Health Center, Indian Health Service, Zuni, New Mexico; and Center for Information Technology, National Institutes of Health, Bethesda, MD.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Steele
authors.affiliation: National Kidney Disease Education Program, National Institutes of Health, Bethesda, MD; Zuni Comprehensive Community Health Center, Indian Health Service, Zuni, New Mexico; and Center for Information Technology, National Institutes of Health, Bethesda, MD.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kempner
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D000071959:Case Managers; D003695:Delivery of Health Care / Q000458:organization & administration*; D003928:Diabetic Nephropathies / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D009316:National Institutes of Health (U.S.); D000072104:Nephrologists; D009398:Nephrology; D009516:New Mexico; D064691:Nurses, Community Health; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012720:Severity of Illness Index; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States; D016549:United States Indian Health Service / Q000458:organization & administration
keywords: Indian Health Service; Kidney disease; Nephrology consultation; Telehealth; Telemedicine