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Model for State Engagement on CKD June 5, 2011

Model for State Engagement on CKD June 5, 2011. The Texas Experience. Roberto Collazo-Maldonado, M.D. Dallas Nephrology Associates. Conflict of Interest/Disclosures. No financial relationship with the Texas Government or any political parties . Kidney Disease in Texas.

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Model for State Engagement on CKD June 5, 2011

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  1. Model for State Engagement on CKDJune 5, 2011 The Texas Experience Roberto Collazo-Maldonado, M.D. Dallas Nephrology Associates

  2. Conflict of Interest/Disclosures No financial relationship with the Texas Government or any political parties.

  3. Kidney Disease in Texas • 3rd highest prevalence and 2nd highest costs of CKD in U.S. (USRDS 2007) • 46,168 patients with ESRD (ESRD Network 14 2009) • 35,623 on dialysis • 10,545 transplanted • ESRD incidence exceeds the national rate • Texas 377 per million population • (ESRD Network 14 2009) • U.S. 351 per million population • (USRDS 2010)

  4. Texas Dialysis Incidence and Prevalence by Year 1990-2008 Data Source: ESRD Network 14 Annual Report

  5. ESRD Facilities in Texas 1999 = 261 2009 = 528 453 261 50 Non-certified Certified Data Source: ESRD Network 14

  6. Prevalent Primary Diagnosis Data from ESRD Network 14

  7. CKD Disproportionately Affects Certain Racial and Ethnic Populations Data Source: Texas Behavioral Risk Factor Surveillance System, 2007

  8. Texas CKD Affects Mainly the Elderly Data Source: Texas Health Care Information Collection (THCIC), Hospital Discharge Data, Department of State Health Services, 2006

  9. Dialysis Centers in Texas

  10. Dialysis Centers in the Dallas/Fort Worth Metroplex

  11. Texas Wait List for Transplant as of June 1, 2011 Kidney/Pancreas: 149 Pancreas: 66 Heart: 435 Liver: 1787 Kidney: 8259 National: 88,988 Data Source: Southwest Transplant Alliance

  12. Texas Response to Problem • 2007 Legislation: • CKD Task Force • ESRD Prevention Campaign

  13. Chronic Kidney Disease Task Force • Established through passage of HB 1373 (80th Texas Legislature, 2007). • Members appointed by Governor, Lt. Governor, and Speaker of the House. • The CKDTF team consists of experts in nephrology, family practice, dietary, transplantation, education, and state and community agencies. • HB 1373 directed Task Force to study the burden of CKD in Texas, summarize findings and make recommendations to address the problem. • Task Force submitted findings and recommendations in report to legislature, January 2009. Full text of report: www.TDH.state.tx.us/diabetes/ckd.shtm

  14. Chronic Kidney Disease Task Force Members • A. Osama Gaber, MD, Chair Methodist Hospital – Houston • Carolyn Atkins, BS, RN, CCTC Dallas • Roberto Collazo-Maldonado, MD Nephrologist – Dallas • The Honorable Robert Deuell Texas Senate • Lisa Genna, MEd TDH – Austin • The Honorable Ryan Guillen Texas House of Representatives • The Honorable Chris Harris Texas Senate • Jennie Lang House, RD, CSRLD Midland • The Honorable Susan King Texas House of Representatives • Rita Littlefield Texas Renal Coalition – Austin • Elena Longoria Marin, MD Harlingen • Jayaram Naidu, MD Odessa • Charles Nolan, MD UTHSC – San Antonio • Smita Vaidya, PhD UTMB – Galveston • Susan Wiggans Quest Diagnostics – Houston • Marinan Renz Williams Scott and White – Temple

  15. Chronic Kidney Disease Task Force Directed to: Develop a plan to educate clinicians about early screening, diagnosis, and treatment of CKD and its implications based on published clinical guidelines. Develop a plan to educate health professionals and patients with CKD about advantages and options of renal replacement therapy. Make recommendations on a cost-effective plan for early screening, diagnosis, and treatment of CKD for Texans.

  16. CKD Task Force Findings: • CKD is a growing public health problem that remains • Under-recognized • Under-diagnosed • Under-treated • Evidence-based guidelines are underused. • Simple blood and urine tests can identify CKD at early stages. • Early detection, treatment and management can delay disease progression. • CKD is a growing focus for primary care physicians.

  17. Outcome of 81st Legislative Session 2009 • Rider attached to General Appropriations Act allocated money for Texas Tech University to conduct a CKD study, in consultation with the • CKD Task Force • Yield prevalence data by CKD stage • Study costs of CKD care and projected costs over next 10 years • Identify statistically significant subgroups who are at risk • Develop policy recommendations

  18. Outcomes of 81st Legislative Session 2009 • CKD Study • Tier 1: identifies demographics of patients currently being treated for kidney disease • Tier 2: screening study to identify CKD prevalence by stage within primary care clinics • Tier 3: random sample general population screening demonstration project • Study runs through August 31, 2011

  19. Outcomes of 81st Legislative Session 2009 • HB 2055: extended CKD Task Force • through August 31, 2011 • Develop cost-effective plan for prevention, early screening, diagnosis and management of CKD for the state’s population • Develop a plan for surveillance and data analysis to assess the impact of CKD in the state • Submit findings and recommendations to Governor, Lt. Governor, Speaker, and presiding officers of identified Senate and House Committees

  20. ESRD Prevention Campaign • 80th Texas Legislature (2007) appropriated funds for TDH and Texas Renal Coalition to develop and implement a program to decrease the incidence of ESRD in Texas. • Dual campaign: • Love your kidneysandSave their kidneys. • Launched in 2008 in Lubbock, Laredo and Rio Grande Valley markets: 24 counties.

  21. Love Your Kidneys Urges individuals with diabetes, high blood pressure, heart disease, or a family history of kidney problems to get tested for kidney disease. www.lovekidneys.com

  22. Love Your Kidneys • Program components: • TV and radio PSAs • Print ads • Messages in pharmacies and grocery stores • Educational materials • Interactive website • Web banners on • consumer sites

  23. Save Their Kidneys • Urges physicians to test their • at-risk patients • Program components: • Direct mailings to physicians, nurses, dietitians, pharmacists • Professional exhibit and materials • Ads in Texas Medicine, Texas Family Physician • www.savekidneys.com

  24. Campaign Evaluation • In September 2008, UTMB conducted evaluation to determine impact of PSA’s in first tier sites: Laredo, Lubbock, McAllen, Harlingen. • Evaluation focused on 3 short-term outcomes: • Exposure to PSA’s • Impact on awareness of risk factors • Change in behavior • Surveys administered through TDH community diabetes programs.

  25. Impact on Specific Behaviors

  26. Outcomes of 81st Legislative Session 2009 Funds allocated to TDH to continue ESRD Prevention Campaign through 2010-2011 biennium.

  27. Mandatory eGFR HB 2330 (81st Texas Legislature, 2009) requires labs to estimate and report eGFR result when performing a serum creatinine test on a person > 18 years of age. HB 2330 requires physicians to provide person’s age, race/ethnicity and gender when requesting a serum creatinine determination on a person > 18 years of age.

  28. Glenda Dawson Donate Life - Texas Registry • In 2007, state representative Glenda Dawson, herself a kidney transplant recipient, led the effort to create the Glenda Dawson Donate Life Texas Registry. • The program is funded by a $1 voluntary contribution that Texans can make when applying for or renewing their driver’s license, identification card or when registering their vehicle. • The registry is a database of individuals who officially indicated their wish to donate organs upon their death.

  29. Texas Kidney Health Care Program(Kidney Health Care Act – established 1973) • The Medicare ESRD program covers allowable medical and other related costs for dialysis and transplant patients who are enrolled in Medicare. • Most ESRD patients do not receive any ESRD benefits from Medicare until three months after initiation of dialysis. • During the 37-year existence of the KHC program, approximately 104,000 Texans have been approved to receive benefits for access surgery needed for dialysis, drugs and transportation costs incurred in the treatment of ESRD.

  30. Texas Kidney Health Care Program(Kidney Health Care Act – established 1973) • As of August 31, 2010, the KHC program had 19,590 active clients with a total expense of • 17.9 million dollars for fiscal year 2010. • Despite the recent shortfall in the Texas Government budget, legislation has been approved to continue with this important program for patients with kidney disease in Texas.

  31. Microalbuminuria Testing in Medicare Beneficiaries with Diabetes without Nephropathy in the City of Dallas

  32. Dallas CKD Disparities InitiativeDallas Advisory Group to Improve Kidney Testing Among African-Americans with Diabetes

  33. What’s Next? • Task Force – HB 3724 (82nd Texas Legislature, 2011) continues CKD Task Force to implement plan with partners • CKD Study – final outcomes fall 2011 • Love your kidneys, save your kidneys campaigns – continue

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