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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Improving the understanding, detection, and management of kidney disease.

Veterans Affairs (VA) Activities

Quality Improvement/Evidence of Therapy

This 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 (CPG). The VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease was last updated and published in 2008. VA/DoD is in the process of completing a subsequent round of updates with an expected completion date of end-fiscal year 2014. 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 (CKD). 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 United States Preventive Services Task Force. Recommendations for care of patients with CKD 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 also collaborates with the Centers for Medicare and Medicaid Services (CMS) in their quality improvement programs pertaining to dialysis care by reporting to Consolidated Renal Operations in a Web Enabled Network (CROWNWeb).

Contact Information
VHA National Kidney Program
Email: VHANationalKidneyProgramOffice@va.gov
Web:  http://www.medicalsurgical.va.gov/kidney/program.asp

Last Updated: June 1, 2014

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Scientific Research

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 United States; the VA research budget in 2013 was $581 million which supported a renal research portfolio of $19.1 million. The VA Cooperative Studies Program (CSP) is an arm of the VA research program that conducts multisite clinical trials examining issues important to 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).

Contact Information
VHA National Kidney Program
Email: VHANationalKidneyProgramOffice@va.gov
Web:  http://www.medicalsurgical.va.gov/kidney/program.asp

Last Updated: June 1, 2014

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Public Education & Outreach

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 Centers for Disease Control in the review of patient education materials pertaining to chronic kidney disease (CKD). These materials are available to VA providers for patient dissemination within the clinic and are directly available to patients via VA's eKidney Clinic website , as well as through the Department of Defense's clinical practice guideline shopping cart .

VA partnered with the Medical Education Institute in 2012 to develop an interactive web-based learning system, known as the VA eKidney Clinic, to help guide Veterans through the process of managing CKD and making treatment related decisions.  The eKidney Clinic is available to the public in addition to VA patients and providers via the VA National Kidney Program website .

In 2013, VA launched the VA National Kidney Program website . This website provides Veterans with convenient and quick access to a range of kidney related resources including a directory of VA outpatient dialysis facility locations, a list of VA benefits and services specific to the needs of kidney and end stage renal disease patients, and further educational resources.

Contact Information
VHA National Kidney Program
Email: VHANationaKidneyProgramOffice@va.gov
Web:  http://www.medicalsurgical.va.gov/kidney/program.asp

Last Updated: June 1, 2014

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Delivery & Payment of CKD Care

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 chronic kidney disease (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. VA currently cares for over 600,000 Veterans with 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 70 VA dialysis units, or if dialysis services are not directly available, may be treated in the community under VA contracted care. Currently over 15,000 Veterans receive care directly by VA or through the community under VA contracted care. 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 at 5 centers.

Contact Information
VHA National Kidney Program
Email: VHANationaKidneyProgramOffice@va.gov
Web: http://www.medicalsurgical.va.gov/kidney/program.asp

Last Updated: June 1, 2014

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Professional Education & Outreach

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. 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 (CPG). The VA in collaboration with the Department of Defense (DoD), created the first evidenced-based (CPG) pertaining to the management of chronic kidney disease (CKD) within the primary care setting in the United States. The VA/DoD CKD guideline, initially issued in 2001 and reissued in 2008, is under subsequent revision 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 CPG. These materials are available to VA specialty and primary care providers via VA's HealthQuality website  and the DoD’s clinical practice guideline shopping cart website .

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 collaborated with DoD in developing a continuing education program pertaining to the CKD CPG for physicians, advanced practice nurses, physician assistants.

Contact Information
VHA National Kidney Program
Email: VHANationalKidneyProgramOffice@va.gov
Web:  http://www.medicalsurgical.va.gov/kidney/program.asp

Last Updated: June 1, 2014

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Surveillance

This section describes surveillance activities and programs of the Federal government related to chronic kidney disease.

Veterans Affairs (VA)

VA has recently partnered with the University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) to develop a comprehensive national chronic kidney disease registry.  The purpose of this registry is to identify Veterans at risk of kidney disease and those with established acute kidney injury, chronic kidney disease or end stage renal disease and further track the burden of disease in these patients and processes of care and health outcomes over time.  Registry Steering Committee members and Advisory Committee members were selected in both VA and UM-KECC who are subject matter experts, specialists and consultants.

VA has also partnered with the Centers for Disease Control (CDC) serving as a reference health care population in the CDC’s Chronic Kidney Disease Surveillance System.

Contact Information
VHA National Kidney Program
Email: VHANationalKidneyProgramOffice@va.gov
Web:  http://www.medicalsurgical.va.gov/kidney/program.asp

Last Updated: June 1, 2014

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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 4, 2014