Show Me CKDintercept Initiative: A Collective Impact Approach to Improve Population Health in Missouri

Abstract

Ninety percent of people with chronic kidney disease (CKD) remain undiagnosed, most people at risk do not receive guideline-concordant testing, and disparities of care and outcomes exist across all stages of the disease. To improve CKD diagnosis and management across primary care, the National Kidney Foundation launched a collective impact (CI) initiative known as Show Me CKDintercept. The initiative was implemented in Missouri, USA from January 2021 to June 2022, using a data strategy, stakeholder engagement and relationship mapping, learning in action working groups (LAWG), and a virtual leadership summit. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to evaluate success. The initiative united 159 stakeholders from 81 organizations (Reach) to create an urgency for change and engage new CKD champions (Effectiveness). The adoption resulted in 53% of participants committed to advancing the roadmap (Adoption). Short-term results reported success in laying a foundation for CI across Missouri. The long-term success of the CI initiative in addressing the public health burden of kidney disease remains to be determined. The project reported the potential use of a CI initiative to build leadership consensus to drive measurable public health improvements nationwide.

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Show Me CKDintercept methods for collective impact—visual depiction. This flow chart displays the key processes used to launch a collective impact (CI) effort in Missouri. Critical steps taken include as follows: (1) Utilization of statewide CKD data to lay a foundational case for action; (2) Engagement of key stakeholders across various sectors for participation in 1 of 4 learning and action working groups (LAWG) titled: Clinical considerations for CKD in primary care, Engaging community and community-based solutions, Wellness and prevention, and Policy, payment, and quality measurement. Of 111 invitations, 58 stakeholders across 40 institutions agreed to participate in a LAWG. Through 16 hours of facilitated discussions the LAWG identified 12 recommended strategies to improve diagnosis and management of CKD in primary care. These recommendations were then used to compose the statewide strategy or roadmap that was launched at the Show Me CKDintercept Leadership Summit (Step 3). Total of 134 stakeholders across 71 organizations attended this live webinar, and 71 of these individuals made commitments to advance 1 or more recommendations. The last step is recommendation implementation where these 71 stakeholders are supporting the execution of strategies. Further stakeholder engagement is being conducted to expand reach and participation, and data is being monitored to measure the impact. To date, 159 individuals from 81 organizations participated in 1 or more steps in the CI process.