Chronic kidney disease (CKD) affects 20 million Americans. CKD can lead to end stage renal disease and is associated with cardiovascular morbidity and mortality. Early management focused on blood pressure control decreases cardiovascular morbidity and mortality and may ameliorate kidney disease progression. Yet, less than 40% of patients with CKD achieve recommended blood pressure targets. There are many barriers to achieving good blood pressure control. One patient-centric barrier we can target is that many CKD patients do not understand the health implications of CKD or what they need to do to optimize their health. Thus, promoting patient behaviors to improve outcomes, including blood pressure control, requires coordinated programs of education and support over time. However, a sustainable, evidence-based model for this does not exist for CKD. The central hypothesis of this study is that early patient CKD education combined with health coach support will improve patient behaviors aligned with blood pressure control by increasing patient knowledge, self-efficacy, and motivation. These in turn will lead to optimal health behaviors and improved blood pressure control. The long-term goal of this research is to develop, test, and disseminate sustainable patient-centric education and coaching support interventions to improve quality and outcomes in CKD. The objective of this proposal is to test the impact of a pilot-tested, provider-delivered patient education tool, followed with health coaching focused on blood pressure control. A cluster-randomized controlled trial will compare outcomes in patients with CKD stages 3-5 between intervention and control groups in primary care settings. Continuous quality improvement and systems methodologies will be used to optimize resource neutrality and identify how to leverage existing technology and resources to support implementation and future dissemination. Involving local partners from a state-wide primary care practice-based research network will support future transferability and uptake into community settings. This research is innovative because it represents a new and substantially different approach to addressing an important public health problem by focusing early in the care continuum to educate patients about CKD and supporting them in achieving clinical health targets by giving them coach support. Continuous quality improvement and systems methodologies will reinforce efficiency in the process, which is critical to future uptake in real-world practice. The proposed research is significant as it will result in a rigorously- tested, provider-delivered patient education tool and an efficient process for follow up that supports patients early in the care continuum. The end result will be a streamlined and efficient intervention that is well-poised for dissemination into community practice settings.
The proposed research is relevant to public health because it addresses an unmet need to reduce the growing epidemic of kidney disease and its complications, and enhance the lives of patients living with kidney disease. The proposed research is relevant to the NIH?s mission of ?developing fundamental knowledge about the nature and behavior of living systems? and applying that knowledge to enhance health, lengthen life, and reduce illness in the 20 million Americans with kidney disease.