- The rate of kidney failure in Native American adults with diabetes has dropped by 54 percent between 1996 and 2013 thanks to the implementation of proactive, patient-centered population health management programs, said the Centers for Disease Control in a new Vital Signs report.
Increased funding for diabetes education and management, along with improved tracking of chronic kidney disease patterns, has produced “remarkable” and “tremendous” improvements in the rate of kidney disease related to diabetes among patients in the Indian Health Service (IHS).
“The 54 percent decline in kidney failure from diabetes followed implementation of public health and population approaches to diabetes as well as improvements in clinical care by the IHS,” said Mary L. Smith, Indian Health Service principal deputy director. “We believe these strategies can be effective in any population. The patient, family, and community are all key partners in managing chronic diseases, including diabetes.”
Native Americans are significantly more likely to experience kidney failure than any other ethnic group, the CDC says, and are also most likely to develop the disease due to complications from diabetes. In 2 out of 3 Native Americans with kidney failure, diabetes was cause.
Native Americans are twice as likely to have diabetes as whites, and have the highest rates of diabetes out of any ethnic group.
To address these ethnic disparities, the IHS worked with stakeholders to develop population health management programs focused on improving chronic disease management, opening up communication with the community, and preventing kidney failure.
These efforts helped to increase the delivery of kidney-protective medications from 42 percent to 74 percent in five years, improve blood pressure control in patients with hypertension, and boost blood sugar control by ten percent.
Senior Native American patients received kidney health testing fifty percent more often than the overall diabetic Medicare population due to better outreach and patient engagement.
Policy strategies driving these results include team-based care, care management, patient education, community outreach, and appropriate screening and medicine for chronic kidney disease in diabetic patients.
The CDC suggests that payers to implement population health management into their diabetic populations, due to the expensive cost to treat kidney failure from diabetes. Medicare spent $14 billion dollars in 2013 just for diabetes-based kidney failure, with the average cost per person at $82,000. Payers can also set standards and tracking performance measures that require health plans to assess the health of their diabetic populations.
Meanwhile, providers can implement population health approaches to diabetes care such as connecting patients with proper nutrition options, transportation, and social resources that promote wellness, developing coordinated care teams for diabetes that help manage outcomes, and integrating kidney disease education into routine diabetic care.
"The Indian Health Service has made tremendous progress by applying population health and team-based approaches to diabetes and kidney care,” said CDC Director Tom Frieden MD, MPH. “Strong coordinated clinical care and education, community outreach and environmental changes can make a dramatic difference in reducing complications from diabetes for all Americans.”