Learning Collaborative: Diabetes & CKD Disparities
Chronic kidney disease (CKD) is a common comorbidity for individuals with diabetes. Unfortunately, it frequently goes undiagnosed. Why is this a priority for us?
Diabetes is the leading cause of CKD in the United States (US).
CKD is an independent risk factor for cardiovascular events and death in people with diabetes.
People living with comorbid kidney disease with their diabetes have amplified risk for a cardiovascular event and that often proves lethal before they even reach kidney failure and the need for dialysis.
Data demonstrate a significant association with social determinants of health and earlier appearance of renal injury markers, namely reduced eGFR, hyperfiltration, and higher levels of urinary inflammatory biomarkers.
Minoritized populations with diabetes have a higher prevalence and risk to develop CKD but they are less likely to be diagnosed with CKD compared to their non-Hispanic white counterparts.
Racial minorities have a greater risk of progressing from CKD to end-stage renal disease (ESRD) and progress more rapidly than their non-Hispanic white counterparts.
Kidney failure prevalence is greater in minoritized populations compared to their non-Hispanic white counterparts:
About 3.7 times greater in Black or African American people, 1.5 times greater in Hispanic or Latinx people, 1.4 times greater in American Indians or Alaska Natives, and 1.5 times greater in Asian Americans than in white Americans.
People who are Black comprise 13% of the US population but 33% of the nation's population on dialysis for kidney failure.
ESRD is nearly 58% higher in Hispanic populations than non-Hispanic populations.
Inequities begin long before kidney failure: Black or African American and Hispanic or Latinx people are significantly less likely than their white counterparts to receive any kidney care before kidney failure, missing key opportunities for intervention.
To draw attention to this national issue, EDAN launched a dedicated collaborative of three regional ECHO hub teams to create programming focused on Diabetes Disparities & CKD.
The goals of the collaborative are to:
Leverage Project ECHO® (Extension for Community Healthcare Outcomes) model to expand the capacity of community health centers to deliver high-quality, equitable care to diverse, underserved patients with chronic kidney disease (CKD) associated with diabetes.
Improve the capacity of primary care clinicians in screening, diagnosing, and managing CKD.
Amplify the call to action to eradicate disparities in diabetes CKD screening.
Create durable outputs that enable the spread of the ECHO model addressing diabetes CKD disparities.
Diabetes Disparities Learning Collaborative: Addressing Diabetes Disparities with Project ECHO®: A Focus on Diabetes-Related CKD
EDAN assembled and funded the first Project ECHO learning collaborative to implement ECHO programming with similar guiding principles and priority areas around diabetes.
EDAN managed an RFP to existing US-based ECHO programming infrastructure with a proven track record and the administrative capacity to operationalize a new diabetes-related ECHO program within 6-12 months (launched Sep 2022 - Jan 2023). EDAN prioritized hubs based on a hub’s focus on community outreach and collaborations targeting “spoke” sites with clinicians in safety-net/community-focused settings (e.g., FQHCs and FQHC-look-alikes) with a commitment to system change as evidenced by engagement with managed care organizations and/or state Medicaid agencies.
EDAN awarded funding to 3 ECHO hubs programs (University of Washington, Rutgers, The State University of New Jersey, and University of Colorado) to create regional ECHOs focused on diabetes and CKD. These teams developed and implemented ECHOs consisting of 8 to 18 sessions. For this program we had 582 learners, 251 unique learners, and average session participation of 28.
Collaborative members engaged in best-practice and resource sharing with other awardees, including twice-monthly one-hour collaborative Zoom meetings. Participants developed shared didactic topics and learning objectives for case presentations.
Shared outcomes assessment, including questions/measurements focused on changes in prescribing, ability, confidence, self-efficacy, and knowledge were developed with input from awardees and used for aggregated assessment of the programs that demonstrated improved PCP knowledge, confidence and change in practice. This demonstrated feasibility of shared multi-site learner evaluation.
Collaborative members participated in the development of an implementation toolkit for local ECHO programs to incorporate ECHO diabetes-related CKD curriculum into existing ECHO programs. The toolkit is now being converted into an interactive module.