Back
Patients with chronic kidney disease (CKD) have high rates of morbidity and mortality compared to the general population. In Ontario, multidisciplinary clinics (Multi-Care Kidney Clinics; MCKC) have been designed to help minimize the morbidity and mortality of progressive CKD. The criteria for referral to MCKC are set by Ontario’s provincial renal agency, and are based on the risk of kidney failure or on the degree of renal impairment.
From January to December 2020, only 51% of eligible patients were referred to MCKC at our center, well below the provincial target of 70%. Since patients may have multiple visits while eligible for MCKC before they are referred, we completed an audit and found that 10% of eligible patients were referred at each eligible visit.
We used quality improvement methods outlined by the Institute for Healthcare Improvement and conducted a time series analysis. Interventions were chosen based on data form our Ishikawa diagram, Pareto chart and driver diagram. Our key interventions were focused on trainee education, cost analysis to add more clinic space and nursing led referrals. The percentage of eligible patients referred at each eligible visit in 2-week intervals was tracked as the primary outcome measure.
The overall referral rate of eligible patients to MCKC increased from 51% to 69% post-intervention. The rate of eligible patients referred to MCKC at each eligible clinic visit increased from the baseline of 10% to 31.3%. The completion rate for nursing-based referrals was 94% and the mean physician acceptance rate for referrals was 57%.
This quality improvement study led to an increase in the referral rate for eligible patients into MCKC. This could lead to improved health outcomes associated with multidisciplinary care models for patients advanced chronic kidney disease. Future work will focus on assessing the sustainability of this improvement and adding smaller scale changes as needed.
* Initial data was submitted at Canadian Society of Nephrology Conference 2023*