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Pankaj Jawa, MD
Pankaj Jawa, MD

Populations at risk for chronic kidney disease (CKD) often go untested because patients with early CKD have few or no symptoms to indicate kidney damage. Medical costs attributable to CKD rise as the severity of CKD increases. Identifying and treating CKD in the earlier stages can offer the highest value of care and the best patient outcomes.

In the newest Value-Care Action Group (VCAG) project, Pankaj Jawa, MD, associate professor of medicine in the division of nephrology and hypertension will institute a pathway to identify high-risk populations for CKD with primary care physicians and order the appropriate tests to diagnose and manage CKD in primary care. Implementing the CKD pathway may reduce total medical visits and move more care to primary care, ultimately reducing costs and opening up specialty access for patients at high risk of CKD progression.

Jawa says there is a high prevalence of CKD and disparities among patients progressing towards end-stage kidney disease, based on data from the U.S. Renal Data System’s 2020 Annual Report.

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High-value is defined by the quality of patient-centered care achieved per unit of cost, derived from measuring health outcomes against the cost of delivering the outcomes.

“In order to slow the progression of CKD, nephrologists and primary care physicians must work together to understand and remove the barriers to care,” he said. “Primary care physicians see patients more often than specialists, and frequently, there is a duplication of care.”

Jawa, who is medical director of UNC Hospitals Kidney and Hypertension Specialty Clinic, suggests a pathway where primary care physicians manage stable CKD stage 1-3 patients, consulting nephrology only if there is worsening CKD or specific questions.

“There are more primary care physicians than nephrologists interacting with our patients. So, the idea is that the primary care physician can start, and continue the management of early CKD, without a nephrology consultation.”

Primary care physicians are already addressing many of the modifiable CKD factors, such as diabetes and hypertension. The new pathway will guide primary care physicians in the management of CKD, with guidelines for referring patients to a nephrologist.

About Value-Care Action Group

VCAG encourages the review of current practices, looking for improvements for high-value outcomes in healthcare. High-value is defined by the quality of patient-centered care achieved per unit of cost, derived from measuring health outcomes against the cost of delivering the outcomes. Ron Falk, MD, chair of the department of medicine, created the Value-Care Action Group (VCAG) in 2016 and appointed value-care champions in each medicine division. VCAG projects have included the outpatient diuresis clinic, the inpatient diabetes management service and a patient education initiative that has improved care for cancer patients while reducing unnecessary visits to the ED. New VCAG awardees and projects for FY-2022 were recently announced. Scott Keller is the director of business development keeping the team focused on value-oriented care models. Darren DeWalt, MD, serves as medical director for the team and helps define the projects. John Vargas is the project manager.