Colleague Connection

U of M Nephrologist Improves Healthcare for Veterans with New Data System

Rajiv Saran, M.D., professor of internal medicine at the University of Michigan, is leading an effort to improve the quality of healthcare for U.S. veterans facing chronic kidney disease.

According to an abstract Rajiv presented at the National Kidney Foundation’s 2017 Spring Clinical Meeting, the total cost of CKD care in the Department of Veterans Affairs healthcare system increased from $12 billion in 2006 to $19 billion in 2014 in current dollars. Adjusted for inflation, the increase was 26 percent.

“Until now, the VA has not recognized the costs associated with CKD,” says Rajiv. “Now the VA recognizes kidney disease as a health priority amongst other chronic conditions such as mental health, diabetes and cardiovascular disease.”

More than three-fourths of the VA's aggregate spending each year on CKD patients was dedicated to patients with either stage 3a or 3b disease. However, the average cost per patient to treat increased with each worsening stage of CKD, with non-dialysis stage 5 CKD being the most expensive.

As a result of these preliminary findings, Saran and colleagues established the VA Renal Information System, a capacity building health IT innovation that systematically focuses on and tracks all stages and types of kidney disease among U.S. veterans throughout the VA health system. It is meant to serve as a tool for research, quality improvement and population health management.

“A foundational electronic medical records based information system has been created for the VA that will allow multiple functions for improving care of veterans with CKD and if further enhanced could serve as a kidney disease surveillance, research and population health management tool,” says Saran.

Approximately 7 million VA patients are included in the VA-REINS system, all of whom visited a VA facility at least once during a span of three federal fiscal years. There were 1.1 million VA users identified as having CKD through a restrictive definition, which included a persistent eGFR of less than 60 mL/min/1.73 m2, with any evidence of proteinuria marked by severe or moderate AER/ACR/PCR/PER, or an ICD-9 diagnosis.

As the overall burden of kidney disease remains high in the United States, the disease’s impact on vulnerable populations, such as veterans, is important to evaluate.

Saran says the newly established VA-REINS has great potential for population-based cost tracking, as well as disease management, surveillance, and prevention. In the future, the system is slated to have the ability to deliver individualized care for patients with physician reports, as well.

The research teamin the process of finalizing a paper for submission during the first quarter of 2018.