U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Improving the understanding, detection, and management of kidney disease.
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Learn MoreThis section describes current quality improvement and evidence of therapy programs of the Federal government related to chronic kidney disease.
Veterans Affairs (VA)
The VA and Department of Defense (DoD) work collaboratively to develop evidence-based clinical practice guidelines. The VA/DoD Clinical Practice Guideline (CPG) for the Management of Chronic Kidney Disease was updated and published in 2008. The VA/DoD guideline development process follows a rigorous evidence review and grading process. Guideline champions are selected in both VA and DoD who are subject matter experts, specialists and consultants or who are doing research in the field. Guideline working group members are selected across the VA and DoD and are part of interdisciplinary teams caring for patients with chronic kidney disease. The guideline working group members develop researchable questions based on the PICO format (problem, intervention, comparison, and outcome) and review the evidence presented in some of the national and international guidelines. There is a contract with an Evidence-Based organization to do a systematic review of the literature and present evidence synthesis to the working group members to minimize bias. Guideline recommendations are developed based on the evidence and graded by the working group members using the same grading process spelled out by the US Preventive Services Task Force. Recommendations for care of patients with chronic kidney disease are outlined in the VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease.
After the guideline is approved and published by the VA/DoD Evidence-Based Working Group, consisting of members from the VA, Army, Air Force and Navy, the VA and DoD collaborate to develop implementation tools, clinical documentation, and quality improvement procedures into the electronic medical information systems. VA and DoD are in the process of developing several CKD encounter form templates as well as referral forms for nephrology consultation, renal nutrition, and vascular access placement to better treat patients.
VA also collaborates with the Center for Medicare and Medicaid Services (CMS) in their quality improvement programs pertaining to dialysis care. All VA dialysis units participate in CMS' Fistula First Breakthrough Initiative (FFBI) and Clinical Performance Measure (CPM) assessments through regular reporting via CROWNWeb.
Contact Information
Susan Crowley, MD
VHA National Program Director for Kidney Disease & Dialysis
Phone: 203-932-5711 ext 3950
Email: Susan.Crowley@va.gov
Web: www.patientcare.va.gov
This section describes basic and clinical research activities supported or sponsored by the Federal government.
Veterans Affairs (VA)
The VA is a major sponsor of scientific research in the US; the VA research budget in 2010 was $580 million. The VA Cooperative Studies Program (CSP) is an arm of the VA research program that conducts multisite clinical trials examining issues important to the veteran health. For nearly two decades the VA CSP has been continuously conducting clinical trials in kidney related research, the results of which have been published in high impact journal such as the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM). VA CSP recently collaborated with the National Institutes of Health (NIH) to perform the largest national trial of renal support in acute kidney injury, the results of which were reported in NEJM in 2008. Analysis of secondary endpoints and ongoing sub-studies are focusing on the impact of acute kidney injury on long term kidney function.
Contact Information
Susan Crowley, MD
VHA National Program Director for Kidney Disease & Dialysis
Phone: 203-932-5711 ext 3950
Email: Susan.Crowley@va.gov
Web: www.patientcare.va.gov
This section describes current outreach and education programs of the Federal government related to chronic kidney disease.
Veterans Affairs (VA)
The VA has been actively collaborating with NKDEP and the CDC in the review of patient education materials pertaining to CKD. These materials will be widely available to VA providers for patient dissemination within the clinic and will be available directly to patients via VA's MyHealtheVet website as well as through the DoD's CPG shopping cart at https://www.qmo.amedd.army.mil.
Contact Information
Susan Crowley, MD
VHA National Program Director for Kidney Disease & Dialysis
Phone: 203-932-5711 ext 3950
Email: Susan.Crowley@va.gov
Web: www.patientcare.va.gov
This section describes activities related to the delivery and payment of chronic kidney disease care supported or sponsored by the Federal government.
Veterans Affairs (VA)
The prevalence of CKD in the veteran population is estimated to be 34% higher than in the general population, due to demographic differences and the existence of significant co-morbidities associated with CKD in the veteran population - diabetes mellitus and hypertension. The Veteran's Administration (VA) currently cares for over 200,000 veterans with moderate to severe kidney disease in their 153 medical treatment facilities or 800 community based outreach clinics (CBOC's) across the United States. Those veterans who progress to kidney failure are treated either at home or in one of the 60+ VA dialysis units, or if dialysis services are not directly available, may be treated in the community under VA contracted care. Currently over 12,000 veterans receive this benefit. Eligible veterans may also elect to receive dialysis care in the community using Medicare or other personal health benefits programs. Renal transplantation is also offered through the VA as a regionalized service.
Contact Information
Susan Crowley, MD
VHA National Program Director for Kidney Disease & Dialysis
Phone: 203-932-5711 ext 3950
Email: Susan.Crowley@va.gov
Web: www.patientcare.va.gov
This section describes education and outreach to health professionals of the Federal government related to chronic kidney disease.
Veterans Affairs (VA)
The VA is widely recognized as the largest provider of graduate medical education (GME) in the United States. The Undersecretary for Health of the Veterans Health Administration is a statutory member of the Council on Graduate Medical Education (COGME). Graduate medical education has traditionally been supported and centered in VA medical facilities associated with academic affiliates.
The VA also provides professional education through the development and dissemination of clinical practice guidelines. The VA in collaboration with the Department of Defense (DoD), created the first evidenced based clinical practice guideline pertaining to the management of chronic kidney disease within the primary care setting in the US. The VA/DoD chronic kidney disease (CKD) guideline, initially issued in 2001, was recently revised and reissued in 2008 to reflect current research.
VA has also been actively collaborating with NKDEP since 2009 in the development of healthcare provider education materials pertaining to CKD. The purpose of such efforts is to promote provider understanding of CKD and its treatment, and foster adoption and implementation of the VA/DoD CKD clinical practice guideline. These materials are available to VA specialty and primary care providers via the VA Renal Sharepoint and the Army Medical Department CPG shopping cart and website at https://www.qmo.amedd.army.mil.
The VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease also provides a concise summary of evidence-based recommendations on treatment of CKD and complications. The VA is collaborating with the DoD in developing a continuing education program pertaining to the CKD practice guideline for physicians, advanced practice nurses, physician assistants.
Contact Information
Susan Crowley, MD
VHA National Program Director for Kidney Disease & Dialysis
Phone: 203-932-5711 ext 3950
Email: Susan.Crowley@va.gov
Web: www.patientcare.va.gov
This section describes surveillance activities and programs of the Federal government related to chronic kidney disease.
Veterans Affairs (VA)
The VA/DoD Clinical Practice Guideline for Diabetes Mellitus recommends monitoring of diabetics for the development of albuminuria. This is the same metric recommended by the National Diabetes Quality Improvement Alliance.
The VA has recently begun collaborating with the VA Office of Quality and Performance (OQP) to examine the implementation of the VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease within the primary care setting. The purpose of this CKD pilot metric project is to assess primary care provider recognition of CKD following the release of the CKD clinical practice guideline.
Contact Information
Susan Crowley, MD
VHA National Program Director for Kidney Disease & Dialysis
Phone: 203-932-5711 ext 3950
Email: Susan.Crowley@va.gov
Web: www.patientcare.va.gov
This information was reviewed by KICC agency representatives. It may not reflect new or future agency activities. For more information, please contact the listed representatives.
Page last updated: June 6, 2012
NKDEP is an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), U.S. Department of Health & Human Services (HHS)
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