Taking Healthcare by Storm: Industry Insights with Jillian Pate

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Jillian Pate, MS, RD, CSR, LD, a Renal Dietitian Nutritionist.

Learn more about the West Virginia CKD Program.
Contact Jillian.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website: https://www.qualityinsights.org/qin/taking-healthcare-by-storm

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-110724-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello everyone and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, Medical Director of Quality Insights and today we have I think, I think we have Jillian is the only guest that's been on the podcast three times, which is very exciting. She is certainly a favorite on the podcast.

So today we have Jillian Pate. She is a renal dietitian, and we're going to be getting a follow up. With the West Virginia CKD prevention program, CKD, Chronic Kidney Disease, is something that is very prevalent in West Virginia, and it is a condition that many might not know that they are developing, or that they are at risk of developing, maybe because they have high blood pressure.

for diabetes. So the West Virginia CKD Prevention Program is really aiming at not only saving lives but extending life, improving quality of life. And we are going to be talking today about the important work that Jillian is doing in West Virginia with this program. Jillian, thanks so much for coming back today.

Yeah, thank you so much for having me. So let's just jump in. Let's just recap. Give us a general overview of the West Virginia CKD program and what areas it's operating in. 

Yes. So, um, so this program actually got started at the beginning of 2024. And what our main focus has been on from the very beginning is just helping to kind of bridge the gap.

Of individuals not receiving the proper nutrition interventions they can, um, in the midst of a disease state. So, um, what we did is we created this program that helps these, um, individuals that may have already found out that they have a chronic disease such as, you know, diabetes or kidney disease. Um, and even those that are going through even cardiovascular issues with hypertension.

And what we do is we work with them to, um, you know, really establish a good rapport with these patients and let them really see what it's like to work with a dietitian. Um, it's a six month program. And then if they need more than we can reach back out to their doctors and, you know, kind of go about how we're, how we're going to continue to do our care.

But, but what I love about it is we get these, these patients. six months with these individuals to really just show them the benefit of making nutrition changes that's going to continue to help, um, really kind of halt further progression with their disease state. And with this program, we've really already been able to show so much improvement just by having that opportunity.

Amazing. 

Yeah. And so right now, you know, we do have some focus areas in West Virginia. You know, we're focusing in on Mingo County, Rhone, Jackson, Greenbrier, and Wyoming. Those are kind of some of our target counties where we're just trying to really see the impact we can make in those that may live in more of a rural area.

But ultimately, we're here to help all of West Virginia. So the program is available to anyone in the state. 

So how has the program been received among patients and also how has it been received among nephrologists, kidney doctors? 

Yeah. So I think, you know, when we finally get to have that connection where, um, you know, we're able to touch point with these patients and get something set up and, and we're really explaining the program and what we do, they're almost kind of at a, Wow, this is something we can actually have.

This is something that's offered to us, um, because we are trying to create a program that's going to be sustainable here in West Virginia. And, um, and what I love about it is myself and the five other dietitians that we have working in the program, you know, we're all from West Virginia. We're from in this Appalachian area.

And so we're able to really kind of meet these individuals right where they're at. So as far as the patients go, we've had great, um, great success with their buy in and really just. you know how thankful they are to have these, you know, resources available to them. And it's also helping because for those, um, those patients that are just really excited about it, you know, they're going back to their, their physicians and thankfully expressing how grateful they are that they got referred.

So, you know, at the start of course, with any program, sometimes it's a little slow and, and, you know, there are so many great programs out there. And so to really set our program apart, we've really tried to just show, um, that this is so much more than just another, you know, one year project. We're really trying to look at the sustainability, um, for our patients here in West Virginia.

Yeah, super important. So can you share any success stories? Cause I I'm sure that personalized nutrition therapy and, and support has impacted health outcomes. 

Absolutely. So, um, one of my patients, um, that started earlier in this year, she was, she was a great, um, really a great testament to what the program did for us.

She had been following a nephrologist for a little over a year now. And, um, when we reached out to her nephrologist to let her know what we were doing, she got the referral, got started. And her kidney number, she was actually stage four chronic kidney disease. And, um, and so. So whenever we have an individual like that, you know, we really try to see, okay, where, what can we do at this point, um, you know, try to encourage the patient to not be discouraged because obviously, you know, stage five, um, whenever we're pressing it, that's where we're changing the dialect to talking more about dialysis.

and it gets a lot more real. So at stage four, we just really try to be transparent with our patients, um, but also still try to encourage them right where they're at. And so this patient, she put in the work, she, she stuck to the guidelines that I had provided. And within six months, um, she came back and her GFR continued to improve over the timeframe.

And she went back to stage three and she went back to stage two. And right now her kidney numbers are doing so well. a one C is in range. Um, changes and you know, it a little different for ev but in her circumstance w jumped on, you know, as s that her blood sugar was out of control. Instead of letting more time get away from her, she acknowledged very quickly.

Okay, I need to make a change. And that really is the best opportunity is whenever we can capture those that are kind of earlier in their diagnosis, even with their kidney numbers continuing to decline pretty quickly, we were able to halt further progression. And then, as I just noted, be able to see the improvement just by her making all these dietary changes.

That's huge. I mean, that's amazing. It's unheard of. Right. So we know the chronic kidney disease often goes unnoticed until it is well advanced. So what strategies does the program employ to promote early detection and early management around among high risk individuals? 

Yeah. So a good portion of our patients, you know, by the time we see them, they have already been diagnosed with stage three at the earliest, you know, is where we're kind of seeing it.

So we're seeing a lot of stage three, um, kidney disease patients. And so what we try to do is we just try to stay, um, on them to be consistent. And then also for them to recognize that where they're at. It might look a little different from, you know, a family member and things like that. You know, we're also running into a lot of autoimmune diseases that are, um, unfortunately affecting their kidneys.

So that's something we've been running into and it's given us the opportunity to educate the patient as well as try to encourage the patient to educate the family about earlier prevention and what we can do before, you know, their family member might get to the same stage they are and, um, and really try to implement, like, how can we bring more awareness.

Um, we're also, we've been talking to a lot of different healthcare settings in West Virginia on different ways that we can make more of a community approach, um, because we're all here for the same reason, right? So it's just kind of collaborating and finding opportunities for us to continue to show what we have to offer, um, so that way we don't have to continue to see this disease state take over our state.

Yeah, absolutely. And we know, you know, CKD is involves many, many other chronic diseases. So does the program integrate other health care providers to ensure, um, participants are getting treated for chronic kidney disease and diabetes and hypertension and all of those chronic diseases? I'm assuring I'm assuring.

I'm sure that the dietary interventions probably help all of those chronic diseases as well. 

Yeah. And, and, you know, that's something we do also talk about, you know, we make sure that not only are we talking about what they're eating, but we also look at their day to day and how they are managing their diabetes, how they're managing their, you know, their blood sugar, their blood pressure, kind of some of the steps that they're taking and what we like to do as providers.

On the nutrition side is we just make sure to document accordingly because we want to be able to report back to their doctor. So that way, you know, we're all on the same page as far as that. There's any areas that we feel would be more beneficial for them. Um, that's what we start. And even when it comes down to us, encouraging them at certain points that we're working with them to, you know, to do a food blog, well, not only are we going to have them do a food blog, but we're also going to have them make sure you're writing down you and, you know, your, your vitals and labs and things that we know are pertinent, but it also helps them get into a good routine as we're making these changes to not forget about the other things that are just as important.

Yeah, absolutely. So it's a high prevalence of chronic kidney disease in West Virginia. We talked about earlier. So what are some common misconceptions about CKD that you've encountered and, and how does the program work to kind of dispel these myths? 

Yeah, so I think, you know, I think with CKD, I think a lot of times, you know, it is, it's kind of not been out um, on people's radar, you know, there's other chronic disease states that have, you know, the verbiage has been there for years, you know, I have diabetes, you know, I have sugar, I have, you know, high blood pressure, you know, and they kind of go about, and it gets kind of dismissed, but then when kidney disease comes about, where I think it is so, um, so many people don't know a lot about it, and We kind of go one way or the other.

We either get very overwhelmed and we go straight to looking online and like all the, all the misconceptions that come from it and how to, how to treat it. Um, to the point of where we just dismiss CKD as well. And, you know, unfortunately, once you have chronic kidney disease, it's not one of those things that you can turn your eye to once that happens, you know, your kidneys are vital organs and they affect a lot of, um, they affect a lot of what our bodies do and function.

And unfortunately, you know, if we do dismiss it, we will start seeing Seeing the symptoms that come from it. So what we have been trying to do is just continue to, um, not have people be so overwhelmed by the do diagnosis. I think the more that we can talk about CKD and how we can talk about how there are opportunities for us to manage CKD.

I think that that is hopefully going to be encouraging enough for people to be like, Oh, there's something I can do about this instead of just quickly feeling so overwhelmed by all their different health, um, their health, you know, diagnoses and issues that they just kind of shut down. And they're almost too overwhelmed to make any interventions whatsoever.

Yeah. And fear is never a good place to operate from. So helping them get over that fear I think is so very important. Absolutely. So have you learned anything surprising from the program? 

Um, you know, I think, you know, I think what something that we're kind of still working here in West Virginia and I, and I say it a lot to my colleagues is that we're still doing a lot of trailblazing.

If I'm being honest, I think that's one thing that, you know, even though we have come a long way with the different, you know, healthcare initiatives we try to bring to this state, we're still very much trying to trailblaze. And I think it's still been kind of baffling how. You know, challenging it can be to have dieticians be a part of the care team.

Um, but that's one of the things that, you know, why we started this program is that we're going to continue just to show if, if they can allow us to, to come in and provide our expertise along with their expertise. It's not just a one man show, you know, I think that we're going to continue to see success with helping our patients.

But I think that's probably the biggest thing that it's. Like we're still trying to tread and, and get in there and, and have to kind of validate ourselves as professionals. But I also know that the more that we work together and we all come together with an understanding of what we're doing, um, I continue to see more of a buy in of what we're doing.

That's wonderful. So if you had your wishlist, your, your Christmas wishlist for the West Virginia CKD program, what would it be? What are your hopes for their future? And do you have any? Are there any plans in place for expansion or new initiatives? 

Yeah, so what we're working on right now is we are working into expanding for at least another year of our program because we're kind of really just still getting a good foundation of what we're doing.

Um, we've really just kind of touched the surface of what the individuals that we've been able to have. Um, something that we started from the very beginning is not only did we want to get rapport with different physicians, um, here in the state to kind of know about our program, but what we wanted to do is we wanted to implement something that could come from an acute care setting, you know, where people are not having this.

big gap, but whenever they're finding out their diagnoses or they're hospitalized for certain issues that we can, once you're discharged, jump on being that care, you know, just like therapist and, you know, other different providers can kind of jump in and give their aid in that time of need us as dietitians, we want to hop in and we want to be able to, to kind of bridge that gap of where a lot of times we have to wait a certain timeframe before these patients see us.

And at that point, they've kind of already settled into almost an acceptance of their diagnosis. They've settled into a little bit of discouragement, sometimes depression, you know, and there's been too much space between the time of, of their diagnosis, hospitalization to actually getting to work with us.

So we're trying to, we're really trying to bridge that gap because I know that we're going to see benefits whenever we can, whenever we can just show, um, what we can do. And then also, um, really, you know, encourage, you know, no hospitalizations. especially if it's a patient that continues to get readmitted for the same issues, you know, you know, if there's things that we can take care of and not be hospitalized, I feel like that would be a great way to, to allow them to see like, it's worth pursuing.

It's worth having a dietitian on your team. 

Yes. I think anyone, if you can prevent, Anyone from going into the hospital, I think they would be on board. Most definitely. Yeah, so shifting a little bit, but I, you know, I recently had a conversation with Jesse Cubillo, um, who is a, um, patient engagement specialist with our end stage renal disease network, and we were talking about emergency preparedness around.

with patients who have CKD. And so I really would love to just ask you one question around emergency preparedness because recently we've seen so many natural disasters in the news. Lots of hurricanes recently, and I know they've affected individuals with CKD. People have lost power and they've lost services for a long period of time.

Can you give us some dietary tips for patients with chronic kidney disease to help them maintain their health during a disaster, especially when access to fresh food might be limited? 

Absolutely, you know, and, and I think a lot of times we even have to look at that here in West Virginia too, whenever we have even harsh winters, you know, and we have that possibility, you know, no matter what state we live in, there's always going to be something that, you know, whether inflicted can cause, you know, our norm, so to speak, our comfort to be kind of like shook.

And so what do we do in those moments to be prepared? Right. And, um, and so a lot of times what I've been kind of working towards right now is Especially, you know, working towards even the winter months, it's like when things like this happen, you know, at the end of the day, we have to know that sometimes our resources are going to be limited.

And that's something we kind of face already here in West Virginia at times, is our resources are limited. So what do we do with that? You know, It would be easy just to be in that moment and you know, there's so much more that's going on than just food, but at the end of the day, we have to make sure that we're nourishing our bodies and we have to make sure that, you know, we're making the best of what we have.

So, you know, ideally, if we have the opportunity and say, you know, we're looking at a situation where there's just power outage or. Things like that, that we're preparing for. I'm always encouraging my patients to have, you know, shelf stable, low sodium options, you know, salt tends to be the biggest indicator.

Um, whenever we look at things in a, in more of an emergency setting, because a lot of our shelf stable items tend to have a lot of salt. So, um, something I've actually been seeing here recently, which has been really encouraging as a lot of like local pantries, um, have been in trying to encourage different alternatives.

to what people are able to donate. Obviously in an ideal world, that would be great to, you know, be able to donate all the things that are, you know, appropriate, but a lot of our local food banks have been doing better with having, um, disease, chronic disease state, like boxes that they have available that contain lower sodium options.

Um, like low sodium peanut butter, low sodium crackers, of course, low sodium chicken broth and any different items that we would normally already receive from someone that would be providing aid. Um, and you know, if for some reason that's not an option and we don't have a low sodium option, we just look at the portion and we just try to be mindful, remind ourselves that it's temporary.

If we notice something has a lot of salt in it, try to just be mindful of the portion. And then if you have accessibility, drink a little bit more water to stay safe. stay hydrated and flush some of that extra salt out. So, I mean, it's always going to depend on what circumstance we face. And, you know, I know in the midst of all of that, we have so many things going on through our mind, like I said.

And so a lot of times we don't even want to think about eating, but at the end of the day, you know, if we can have just that reassurance in the back of our mind that this is temporary, we're going to get through this, you know, and we're going to just. You know, focus on one day at a time what's available to us and not feel like this is our new norm.

So it's, it's more of just, you know, providing that comfort, providing them like, let's just be the prepared we can. Things are going to happen. Um, but obviously we just, you know, we just can't kind of keep going backwards though. We have to look at what's available. Um, and like I said, too, it's been, it's just been really encouraging seeing more food banks have, um, just better options for those that, you know, do have more of a specific guideline.

Yeah, I will agree. It's really wonderful to see, um, those, those food banks have medical, medically indicated food boxes. I think they're just really wonderful. So just great tips, I think, for any, anyone, um, with CKD. So anything else you want to add about the CKD prevention program? Maybe 

put in a little plug.

Yeah. Yeah. So, I mean, what I would just encourage is honestly, if you know anybody that has, um, has had diabetes, you know, that might not realize that, you know, we do need to keep an eye on their kidney levels or someone that you, that you know, that has, you know, had blood pressure or even has already found out that they have kidney disease, you know, What's so great about our program is that we look at the whole picture.

And so we're not going to just give you one side of our story and then have you go off and see other providers. We really try to work hand in hand, um, with your primary care provider, a nephrologist to give you the best, um, you know, the best nutritional advice. So that way you can, you know, halt further progression, you can feel your best, you can continue to remind yourself of why you're doing what you're doing, um, and really continue just to thrive in the season you're at and not allow whatever diagnosis has been thrown at you determine what's ahead for you.

That's wonderful, just wonderful advice. Can, how can interested individuals learn more about the program? 

Yeah, so we have, we have a website, so it's quality insights and then backslash WBCKD dot com. Um, we also have, you know, anytime you, you literally could just type in and I'll provide the resource for you for the link.

But, you know, anyway, there's a There is an insert down at the bottom of it. And I actually do encourage if you're listening to this today and maybe you just want to know a little bit more about the program, you know, our website does a great job. It has a nice video that just quickly describes of what we do.

Um, so you don't have to read a lot of texts or a lot of verbiage, but you can just see a little bit more about what our program entails. And then it has an opportunity for you to fill out a form. It goes directly to us, and then we can contact you and get a little bit more of your information and really just try to make the process as smooth as possible.

Um, one more thing I did want to mention is that we do accept insurance. So our program is a hundred percent free for our participants. Um, And we did that just because we don't want to have finances be a barrier for our patients. And, um, and also just to note too, that all of our stuff is telehealth. So we also just try to not make transportation a barrier either.

So we've really looked at the big picture of how we can best support, you know, our people here in West Virginia. We're happy to serve the Appalachian area, but we just want to make sure the patients know that we're here for him and what resources are available. 

Jillian Pate, wonderful information. Thank you for what you do in, in preventing and managing CKD in West Virginia.

And thank you so much for joining us today. Hey, thank you so much.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.