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Will U.S. Health Care Match Native Americans’ Treatment Of Chronic Kidney Disease?

Discussion in 'Hospital' started by The Good Doctor, May 31, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

    Aug 12, 2020
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    For years, hypertension has dominated the health care field, afflicting 45 percent of all adult Americans. Another disease that has gained renown in the world of health care is diabetes, afflicting 10.5 percent of the U.S. population.

    Health care professionals have allocated untold assets to minimize the impact such diseases pose. Yet, the relative obscurity and lack of funding towards combating chronic kidney disease (CKD) is ironic, considering its impact on the world’s population.

    CKD’s progressive loss of kidney function results in total kidney failure and end-stage renal disease (ESRD). CKD is an ailment that afflicts 15 percent of all adults in the U.S. and a staggering connection to hypertension and diabetes, the two leading causes of CKD, with hypertension being of clinically significant note for care providers.

    While early treatment would diminish the impact of CKD on all fronts, it is rarely diagnosed in its earliest stages. Though diagnosing CKD would only require a trifling blood or urine test, such tests are rarely requested in its early stages due to its relatively innocuous symptoms arousing no immediate concern among patients and care providers.


    By the time patients exhibit symptoms and proactively seek out their care provider, they may have already entered the later stages of CKD, often leading to death. From a humanitarian and monetary standpoint, the U.S. health care system must improve its CKD treatment plan if it wishes to prevent undue suffering on its constituent’s part.

    In 2020, the Center of Medicare and Medicaid Services published a comprehensive guide on primary care for CKD patients. The study noted that racial and ethnic minorities are likely to progress from CKD to ESRD compared to Caucasians and explored potential strategies at containing this epidemic.

    Learning from the Indian Health System

    A notable example of a resounding success in CKD management was found in the Indian Health System’s (IHS) novel strategy on CKD surveillance and treatment. American Indians and Alaska Natives (AIAN) had a whopping 57.3 percent incidence rate for diabetes-related ESRD in 1996. In 2013, that value was cut in half, lowering down to a mere 26.5 percent in 2013. This drastic change corresponded with the IHS’ bold strategy, where they opted to take proactive steps in identifying and treating CKD in early stages.

    The CMS study noted three major steps undertaken by IHS that had a significant effect on patient outcomes. These steps were CKD identification, treatment and monitoring of CKD progression and patient-centered care approach.

    During the COVID-19 pandemic’s worst outbreak, the American Indians and Alaska Native (AIAN) community, like so many others, have adopted lockdown procedures to slow the spread of the disease. Though many may argue the efficacy of the lockdowns themselves, a question very few dare ask is how the lockdowns affected other conditions.

    Due to the local legislature advising residents to stay at home, there have been numerous recorded incidents of weight gain across the country, a phenomenon known as “Covibesity.” With obesity being a major risk factor for both diabetes and hypertension, it would be prudent to enact the IHS’ novel strategy on CKD management on a wider scale.

    Applying the IHS model

    Though the IHS’ strategy at combatting CKD is a model that all other health care systems should aspire to, additional changes are required to apply it. One scalable change is the fact that the IHS’ model only targets CKD for patients with diabetes. Its policy of testing all diabetes patients for CKD on a regular basis would be economically impossible due to the sheer number of patients and tests. Instead, a patient with hypertension would be given regular remote, non-face-to-face checkups for any reported symptoms leading towards CKD.

    When they exhibit the earliest signs of CKD, they would be promptly tested and be further advised on how to maintain their own health. It is a process that can be implemented on a widespread level without stressing our already overtaxed health care system.

    The U.S. health care system can also leverage CMS preventive initiatives such as Annual Wellness Visit (AWV), Chronic Care Management (CCM), and Remote Physiologic Monitoring (RPM) for reimbursement for their services, while improving patient outcomes.

    Integrating preventative health care

    According to the CDC, rural residents suffer from a number of challenges absent in the day to day lives of their urban peers. One of the most notable ones is limited access to health care. Health IT solutions can be brought in for monitoring and tracking patient conditions, they cannot test patients at home, nor can they give life-saving treatments such as dialysis for ESRD patients.

    The CMS’ official strategy guide states a number of strategies to rectify this issue, but they are unlikely to be effective long-term solutions such as waivers to cover travel and allowing health care providers to provide their services up to the limit of their licensure. However, these solutions limit patient quality of life or serve as short-term solutions for the latter.

    Mobility and telemedicine

    Instead, we believe that the next step in health care is not to optimize paths for patients to reach health care providers but to bring health care providers through the use of mobile care units. Mobile care units are vehicles retrofitted to offer clinical care anywhere in the U.S. and manned by licensed care providers.

    The primary benefits for mobile care units are the fact that they decrease patient travel times by arriving at their residences and ensuring that appointments are never missed. It also relieves the stress of finding transportation for dialysis patients, outright eliminating the need for the CMS to find alternative transport methods for patients.

    By utilizing mobile care units alongside health IT solutions for preventive care services, the CMS can finally do the impossible and establish a basic health care standard for rural citizens.

    The above approach is also applicable to address the need for elders in senior living communities and home assisting living facilities.


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