Reviewing and managing chronic kidney disease to improve outcomes
Flagship Program: Intelligent Decision Support to Improve Value and Efficiency
In Australia Chronic kidney disease (CKD) annually affects one in ten adults (1.7 million individuals) and contributes to one in nine deaths, with a further one in three individuals at risk. CKD hospitalisation rates in remote areas are twice as high as in major cities, and Indigenous Australians are four times as likely to die from CKD as non-Indigenous Australians.
Earlier stage CKD is unrecognised in 80-90% of cases, yet these individuals have a 2-3-fold greater risk of cardiac death compared to unaffected individuals. Health care costs increase with the degree of renal impairment, with the treatment of end-stage kidney disease accounting for about 1.6% of the Australian healthcare budget. There is an imminent need for better tools to identify CKD patients and enable early intervention.
The initial phase of this study will utilise linked data to build a state-wide patient registry to establish the current trajectory of individuals with CKD across WA. The registry includes all individuals affected by CKD from 2002 onward, and links pathology results with hospital morbidity and mortality information. The data will be analysed to identify clinical indicators associated with progression from early to advanced CKD, or comorbidities, and the cost of CKD across the life course.
In a second and concurrent phase we will integrate a digital dashboard for system managers and clinicians to better identify those at risk of progression to advanced CKD and costs associated with this. This will allow for more effective patient management and targeting of resources, that support integrated and coordinated care pathways
This study utilises linked data from a state-wide patient dataset to examine the clinical trajectory of individuals with CKD. The dataset includes all individuals affected by CKD in WA between 2002 onward, and links pathology results with hospital morbidity and mortality data. This unique state-wide resource will accurately establish the true epidemiology of CKD through interrogation of pathology records across WA, identifying individuals across the spectrum of CKD severity.
We will then identify risk factors associated with progression from early to advanced stage CKD, and examine clinical variation (with a particular focus on disadvantaged groups, including patients living in rural and remote regions, the elderly, and Aboriginal Australians) that explain the variation in clinical outcomes, with an initial focus on cardiovascular morbidity and mortality. This information will inform evidence-based clinical recommendations to improve the model of care, highlighting resource requirements, and identifying targets for early intervention, leading to better outcomes for patients with CKD.
The second aspect of this study will be to focus on development of a live digital dashboard for effective analysis, visualization and reporting of information that can be used to support both policy and population policy and clinical decision making. The purpose of the dashboard will be to provide early decision support to healthcare providers and risk stratify patient care according to those that need it most. The system will include built in surveillance loops, the ability to initiate a patient trigger based on longitudinal data and multiple composite variables, and provide reporting on Page 37 multiple levels. Additionally the data from the primary, tertiary, government and non-government systems will be automatically extracted, linked and delivered securely to the database.