Appendix A.

Tools included in the advanced CKD patient management toolkit

Tool (intended user)	Intent of tool
Metatool	Serve as a “directory” of tools, provide insight for tool selection and strategies for tailoring to local circumstances
(physician practice intending to use advanced CKD toolkit)
Assessment tool: patient identification	Assess existing practice performance
(physician practice identifying advanced CKD patients)
Assessment tool: patient management	Assess existing practice performance
(physician practice managing advanced CKD patients)
Physician education material	Promote education by identifying patients, using GFR, comanaging patients, and introducing tools
(nephrologists)
Awareness lettera	Raise awareness of CKD, introduce concept of comanagement, promote education
(nephrologist to colleagues)
CKD identification and action plan carda	Promote identification of patients, appropriate timing of consult or referral to nephrologist, and use of guidelines
(referring physicians/physician extenders/nephrologists)
CKD identification and action plan poster	Promote identification of patients, appropriate timing of consult or referral to nephrologist, and use of guidelines
(referring physicians/physician extenders/nephrologists)
GFR calculatora	Identify CKD patients on the basis of GFR instead of serum creatinine
(referring physicians/ physician extenders/nephrologists)
CKD chart flags/stickers	Flag medical records of patients with advanced CKD
(referring physicians/physician extenders/nephrologists)
Referring physician faxback forma	Assure nephrologists obtain important clinical data; allow referring physician to clarify the purpose of referral
(nephrologist to referring physician, faxed back to nephrologist)
CKD postconsult lettera	Communicate comanagement plan to referring physician
(nephrologist to referring physician)
Advanced CKD patient management flow sheet	Serve as a reminder and a standing order; serve as a data repository for use with evaluation tool for patient management
(physician managing advanced CKD patients)
Advanced CKD algorithmsa	Provide implementation guidelines at point of care
(physician/provider managing advanced CKD patients)
Nephrology CPT codesa	Provide nephrology CPT reference codes and documentation guidelines
(nephrologists and providers managing advanced CKD patients)
Supplemental tools (includes eDrugsRenala and PDA Downloads for Toolsa)	Help provide dosage adjustments for patients with CKD and useful web sites for PDA programs
(referring physicians/Physician extenders/nephrologists)
Patient diary (personal health record)(Patient)	Serve as a patient education and self-management tool; serve as both a patient reminder and a patient-initiated physician reminder
CKD class resourcesa	Provide resources for CKD classes and for patient education and self-management
(practice and patient)
Patient education resourcesa	Serve as a resource for patient education tools
(patient and caregiver)
Venipuncture reminder card	Remind patient and health care providers to protect arm veins in nondominant arm for future vascular access
(patient)
Vascular access passport	Provide patient with information on catheter and vascular access placements
(patient)
Postimplementation evaluation tool: Patient identification	Evaluate impact of tools on patient identification and nephrology consult/referral
(practice identifying advanced CKD patients)
Postimplementation evaluation tool: Patient management	Evaluate impact of tools on patient management
(practice managing advanced CKD patients)

Note: Although we use the term “nephrologist,” this group of providers includes all physicians who manage advanced CKD patients.

^aThese tools are suitable for downloading into a hand-held PC device (refer to Palm downloads at www.renalmd.org).