Telehealth by an Interprofessional Team in Patients With CKD: A Randomized Controlled Trial

Ishani, Areef; Christopher, Juleen; Palmer, Deirdre; Otterness, Sara; Clothier, Barbara; Nugent, Sean; Nelson, David B.; Rosenberg, Mark E.; Atwood, Melissa; Bangerter, Ann; Borah, Theresa; Brusilovsky, Olga; Cutting, Andrea; Dobbs, Mia; Elofson, Wendy; Geinert, Kori; Gupta, Kanika; Hackney, K.; Howell, R T; Jarzyna, Miles; Kellerman, Quinn D.; Kroska, Elaine; Krueger, LauraJean; Lalani, Narlina; McCutcheon, Shannon; Otteman, Alec; Plumstead, Megan; Roberts, Bethany R.; Rowe, Keri; Rust, Jackie; Schmitt, Rita; Stockley, Herb; Strutt, Jaclyn; Tambi, Melvis; Weispfennig, Callen

doi:10.1053/j.ajkd.2016.01.018

Cited by 89 publications

(97 citation statements)

References 27 publications

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“…In the first prospective randomized study, Ishani et al [15] tested whether patient to provider home-based videoconferencing improves CKD clinical outcomes when compared to traditional care. After 1 year of follow-up, no differences were detected in the primary endpoints of death, hospitalizations, emergency department visits or admission to skilled nursing facility between the groups; however, a subgroup analysis of rural patients in the telenephrology group showed a trend toward fewer primary endpoints [15], but the power of the study was limited by a low number of high-risk rural CKD patients. On the other hand, our study only enlisted geographically remote CKD subjects who live on average 63 miles from the nephrology centers into telenephrology and compared their outcomes to local routine in-person nephrology care at the Bronx VAMC.…”

Section: Discussionmentioning

confidence: 99%

Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease

et al. 2018

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Background: Chronic kidney disease (CKD) patients who live far (>30 miles) from their nephrologist experience lower rates of clinic visit adherence, limited access to treatment, and higher rates of hospitalization and mortality than patients who live in close proximity to their nephrologist. Strategies to minimize disparities between urban and remotely located CKD patients are needed. The purpose of this study was to determine whether adherence to clinic visits and clinical outcomes in the remote management of CKD via telenephrology is comparable to in-person conventional care. Methods: Renal clinic adherence and composite outcomes of death, end-stage renal disease (ESRD), or doubling of serum creatinine (Cr) were measured in geographically remote Hudson Valley VA Medical Center (HVVAMC) CKD patients enrolled in telenephrology (n = 112) and CKD patients enrolled in the Bronx VAMC renal clinic (n = 116). Results: Prior to implementing the telenephrology service, 53.1% of scheduled visits of rural HVVAMC patients to the Bronx VAMC renal clinic were either cancelled or were “no-shows.” This was reduced by nearly half (28.5%) after instituting telenephrology (p < 0.001). Moreover, the frequency of attending appointments was greater in the telenephrology (71.9%) vs. in-person Bronx VA cohort (61.0%). The incidence of the composite outcome of death, ESRD, or doubling of Cr was similar between both groups (p = 0.96) over 2 years of follow-up. Conclusions: Remote CKD care delivered through telenephrology improves renal clinic visit adherence while delivering comparable renal outcomes. Application of this technology is a promising method to provide access to care to rural CKD patients and to minimize the disparity between urban/rural patients.

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Section: Discussionmentioning

confidence: 99%

Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease

et al. 2018

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“…Patient, nurse and nephrologist satisfaction was high. Seventy seven percent of the patients agreed with the statement “I feel as confident about the doctor’s assessment as I would with an in-person assessment.” Ishani and an interdisciplinary team followed 451 veterans with eGFR< 60 (mean eGFR 37) in the Minneapolis Veterans Affairs (VA) Health Care System and found equivalent outcomes to 150 patients followed in a conventional clinic 9 . The intervention included a home monitoring device for reporting vital signs as well as virtual video visits at home.…”

Section: Ckd and Telehealthmentioning

confidence: 99%

Managing CKD by Telemedicine: The Zuni Telenephrology Clinic

Narva

Romancito

Faber

et al. 2017

Advances in Chronic Kidney Disease

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Telemedicine has significant potential to extend nephrology consultation to rural and isolated communities. We describe a telenephrology clinic which has delivered ongoing consultative care from a nephrologist based at the National Institutes of Health in Bethesda Maryland to the Zuni Comprehensive Health Center in western New Mexico. Over the past nine 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 towards patients with advanced kidney disease (eGFR< 30ml/min/1.73m2). While there are unique aspects to the Indian Health Service and to the Zuni community which is served by this clinic, it 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.

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“…28 Ishani and colleagues randomized 601 veterans with CKD to a tele-monitoring system with direct management by an interdisciplinary team versus usual care. The interdisciplinary team was charged with managing and evaluating BP, volume status, proteinuria, diabetes, cholesterol, depression, health literacy and patient activation.…”

Section: Promise and Limitations Of Telemedicine In Ckdmentioning

confidence: 99%

Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD

Weiner

Fink

2017

Advances in Chronic Kidney Disease

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Chronic kidney disease (CKD) patients have several features conferring upon them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired renal function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated renal function loss, acute kidney injury, end-stage renal disease and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations which hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review we summarize previous assessments of the pre-dialysis CKD populations’ proficiency in using telemedicine modalities and describe the use of interactive voice-response system (IVRS) to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded IVRS use in CKD to address the safety threats inherent to this population.

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Telehealth by an Interprofessional Team in Patients With CKD: A Randomized Controlled Trial

Cited by 89 publications

References 27 publications

Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease

Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease

Managing CKD by Telemedicine: The Zuni Telenephrology Clinic

Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD

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