Innovation Revolutionary: Inclusion and equity in kidney disease treatment

Innovation Revolutionary is a regular series from the VHA Innovation Ecosystem that focuses on VA employees who are disrupting the status-quo, breaking down barriers, and attempting to radically revolutionize Veteran care and employee experience. This post highlights Dr. Priya Joshi, who feels that innovation is about identifying health care challenges for Veterans and committing to navigating them.

Throughout her career, Joshi has sought to identify health care disparities across race and social determinants of health. This can be on an interpersonal level that impedes Veteran engagement or on an outcomes level where certain tests or treatments administered to one group leads to disparate outcomes. This is the space in which Joshi wanted to work when she applied for the Entrepreneur in Residence Fellowship in 2021.

VHA Entrepreneur in Residence fellow

Veterans Health Administration Innovation Ecosystem (VHA IE) offers several fellowship programs for VA employees. These programs offer unique opportunities for emerging and accomplished VA employees with a dynamic presence, passion for innovation, and vision for the future.

The Entrepreneur in Residence Fellowship is for emerging projects that are ready to be tested for real-world impact. Joshi is the chief health informatics officer at the San Francisco VA Medical Center and a 2021 VHA Entrepreneur in Residence Fellow. She came to VHA IE with the goal to improve disparities in the identification and treatment of chronic kidney disease among Veterans.

As a hospitalist, Joshi worked as part of a strong team of VA clinicians and researchers to identify a biomarker relevant in treating kidney disease. While creatinine lab tests are often used to measure kidney function, this method takes the Veteran's race into account and may lead to inaccurate results.

Equity and inclusion in kidney disease treatment

"There are myriad studies acknowledging that there aren't necessarily widespread biological differences between races. The small differences don't warrant the biomarkers taking race into account," said Joshi.

San Francisco VA Medical Center chose to use a new biomarker called Cystatin C, which does not exclude people based on race and does not modify the test based on race, leading to more accurate test results.

"When we found the new biomarker that was so much better and more equitable than the prior biomarker, we had this giant task ahead of us that really centered on one question: How do we implement this to really change outcomes?"

The team created an algorithm that better identifies risk factors for kidney disease, as well as a clinical program to make sure that Veterans receive appropriate kidney care. Joshi's work is called "Equitably Preventing Death, Dialysis, and Cardiovascular Disease Using Advanced Analytics and Clinical Decision Support."

"When I joined the fellowship, I was a hospitalist doing kidney disease work. After I was selected for the fellowship, I was invited to join this significant informatics position at my medical center," Dr. Joshi noted.

"The fellowship allowed me to address this problem that is so prominent everywhere that needs to be fixed. We didn't have to wait to fix it. It allowed us to break down barriers and accelerate through bureaucracy to make sure VA was using equitable biomarkers."

Interested in VHA Fellowships? Learn more on the Fellowships webpage. Want to support VHA IE's innovation revolution? Visit our website to learn about opportunities to become involved in innovation at VA.

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