1. Prevention of Non-Communicable
Diseases by Continuous Learning System
Approaches
(Starting with Kidney Disease)
Rajiv Saran, MBBS, MD, MRCP, MS
Florence E. Bingham Professor of Nephrology
Professor of Medicine and Epidemiology
University of Michigan
Director, United States Renal Data System (USRDS) Coordinating Center
University of Michigan
Ann Arbor, Michigan
2. Key Points
• Why: Non-Communicable Diseases (NCDs)? Why Kidney Disease?
• What: Comprehensive Prevention Strategy
– Going beyond the health system
• How: Principles and Practice of Surveillance & Learning Systems
• Where:
– State of Michigan, USA
– State in India (e.g., Punjab)
– National (e.g., the National VA Health System, USA)
• Invitation to Engage:
– Generating Funding (Grants, Contracts, Donations)
– Bringing a Global NCD Conference to Ann Arbor, Michigan, by 2020
2
3. 3
Why Non-Communicable Diseases?
• NCDs (obesity, cardiovascular diseases, cancer, respiratory
diseases, diabetes, kidney disease, substance abuse and mental
health disorders, etc.) have emerged as the largest global health
crisis of this century
– Nearly 70% of deaths and huge burden of disability worldwide
– Huge Societal Cost
– Current priority mostly downstream crisis management (MI, Stroke,
ESRD, advanced illnesses) – often due to misaligned financial
incentives
– Upstream primary prevention is neglected; easier said than done
4. 4
Why Kidney Disease?
• Simple to diagnose
– Simple laboratory tests
• Well recognized risk factors
• High and rising burden (14.8% of US adult population)
• Very low awareness
• High morbidity and mortality
– ESRD a devastating complication
• Very high societal cost
~120 billion/year for Medicare and the VA health system alone
5. How? Surveillance Systems to Utilize
Learning Health System Principles
5
Data
Collection
Analysis &
Interpretation
Dissemination
Public
Policy /
Practice
Change
Continued
Surveillance
Health Problem
of Interest
6. 6
How?
Establishment of
Robust
Surveillance
Systems
Prediction Analytics
Generate Individual,
Health System and
Population level
(Geospatial) Risk
Profiles
Design & Implement
Tailored Individual,
Health Systems and
Community-level
Messaging to Raise
Awareness and
Motivate Change
Individual, Health Systems &
Community-Level Outcomes
7. 7
Multi-sectoral, Multi-disciplinary,
Committed Partnerships
Michigan
Medicine
School of
Public
Health
School of
Information
Business
School
School of
Engineering
Michigan
Department
of Community
Health
Foundations
(NKF,
Charitable)
Health
Insurers
Federal
Agencies
CMS, CDC,
NIH
Other
Health
Systems
Corporate
Entities
& Private
Donors
National,
State and
Local
Government
8. 8
Active Existing Funding
• Existing and Ongoing Kidney Population Surveillance Systems
at Michigan
– United States Renal Data System (USRDS) (2014 onwards)
– CDC CKD Surveillance System (2006 onwards)
– VA Renal Information System – VA REINS (2012 – 2016)
9. 9
Funding Procurement Efforts – 1
• 100+ Change Competition (MacArthur Foundation) – 2016/17
• Linked up with several key stakeholders at UM
– Michigan Medicine (Internal Medicine/Nephrology, Cardiovascular
Medicine, Diabetes, Family Medicine, etc.)
– School of Public Health (HBHE, Epidemiology, Biostatistics)
– School of Information
– School of Social Work
– Institute for Social Research
– Institute for Health Policy and Innovation
10. 10
Funding Procurement Efforts so Far – 2
• VA Innovations Broad Agency Announcement – 2017/18
– Based upon the VA REnal Information System (VA REINS) created by
our team (2012-2016)
– Collaboration between VA Kidney Program, VA Office of Rural Health,
VA Academic Nephrologists, VA Innovations and Investigators at UM
(Michigan Medicine, IHPI, School of Information and Ann Arbor VA)
– Result Awaited
11. 11
An Invitation to Engage – 1
• To meet this challenge, we are assembling team with expertise
in NCDs, public health, IT, social sciences, health policy,
engineering, law, business, advocacy, and beyond
• Work with us to:
– Refine the vision
– Define the project(s)
– Plan the funding proposal(s)
– Help put plan(s) into action
12. 12
An Invitation to Engage – 2
• U-M recently submitted a concept proposal for the World Federation of
NCDs to host 2020 NCD World Congress in May/June 2020.
• Proposed conference theme: “Promoting Wellness and Prevention of
Chronic Disease through Learning Health Systems and Communities.”
• The UM Proposal was selected from 5 applicant countries
– Opportunity to share early results of LHS NCDs project(s) at U-M.
– Spark a movement – (local, regional, national and global), toward
development of state-of-the-art learning health systems and learning
communities dedicated to prevention of disease
