Nationwide Implementation of a Digital Health Module for Chronic Kidney Disease Screening: A RE-AIM Evaluation in Peru's Social Health System.
Background: Chronic kidney disease (CKD) is a major public health problem, primarily affecting patients with diabetes mellitus and/or hypertension. Early detection is critical to delay progression to renal replacement therapy. Therefore, this study aims to evaluate the implementation of a digital module for CKD detection in at-risk patients within the Peruvian Social Health Insurance system (EsSalud) during 2024. Materials and Methods: Data were collected through the Renal Health Module (MOSARE), a digital tool integrated into EsSalud's electronic health record for monitoring patients at risk of CKD. Key indicators were assessed using the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. Quantitative analyses evaluated patient identification, screening, and diagnosis, while qualitative analyses of technical documents identified barriers, facilitators, and stakeholder perceptions. Results: In 2024, MOSARE was implemented in a population of 1,667,856 insured individuals with CKD-related risk conditions, predominantly women (55.7%) and adults aged >55 years (88.3%). Nationwide, 93,266 patients were screened (5.59% reach), with 34.3% diagnosed with CKD. Screening coverage showed substantial geographic variability (0.35-29.59%). A total of 32,004 CKD cases were identified, with 84.2% in early stages (1-3A). Adoption reached 66.8% of level I and II healthcare facilities, with variability across networks. Regarding maintenance, 65% of trained facilities sustained active use. Implementation gaps were associated with interoperability issues, resource limitations, and training variability. Conclusions: MOSARE proved to be a feasible and operationally sensitive tool for CKD screening and risk identification, improving integration of renal care. However, addressing technical, training, and resource barriers is essential to ensure sustainability and scalability.
Authors
Vidal Orbegozo Vidal Orbegozo, Arce Gallo Arce Gallo, Alamo Palomino Alamo Palomino, Roca Roca, Galarza Galarza, Ticona-Tiña Ticona-Tiña, Arroyo Arroyo, Murillo Carrasco Murillo Carrasco, Apolaya-Segura Apolaya-Segura, Diaz-Obregón Diaz-Obregón
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