Improving care and outcomes of patients with chronic kidney diseases managed in primary care

Nominated Principal Applicant: Dr. Aminu Bello (University of Alberta)

Co-principle applicants from Alberta: Dr. Neil Drummond (University of Alberta), 
                                                          Dr. Paul Ronksley (University of Calgary)

Provinces involved: Alberta, Manitoba, and Ontario

Project description:

We hypothesized that  that development and implementation of CKD surveillance systems using province-wide collated data will: 1) facilitate timely identification of people at high risk for ESKD and CVD; 2) improve use of evidence-based guideline-concordant care; 3) improve understanding of the current standard of CKD management in primary care, and identify care gaps benchmarked against existing quality metrics; 4) serve as a platform to map variation in care across regions and provinces; and 5) identify locations and/or population sub-groups for target interventions that improve care.  

We will leverage the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database to develop an open cohort of CKD patients being managed in primary care in Alberta from January 1, 2010 to December 31, 2015. The CPCSSN database contains information on socio-demographics (age, gender, race, ethnicity, socio-economic status), treatment (renoprotective & cardioprotective medications), laboratory and comorbidities. Patients <18 years of age will be excluded, as will those diagnosed with ESRD and on dialysis or renal transplant. This database is updated quarterly, allowing for identifying new CKD patients who meet the inclusion criteria during the study. 

The CPCSSN collates information across 250 representative sentinels across urban and rural Alberta. Leveraging validated algorithms, case definitions and guidelines will help define CKD and related process of care and outcomes, and enable us to: 1) determine the current practice pattern on CKD risk identification in primary care by ascertaining whether high risk groups (e.g., individuals with diabetes, hypertension, urologic disorders, and use of nephrotoxic medications) have been tested for CKD; 2)ascertain burden of CKD in primary care (case finding); 3)determine and compare the process of identified vs. unidentified cases of CKD using standard quality-of-care indicators, and 4) investigate the variation in care indicators across patients’ demographics (age, sex, socio-economic status, rural/urban residence, comorbidity index) and provider and regional characteristics (rural/urban, solo/group/PCN practice). 

The prevalence of CKD stages 1-5 with 95% confidence interval (CI) will be presented as unadjusted rates, and weighted averages for population rates using the census data. For each sentinel/practice, age-sex standardized prevalence will be calculated, and compared with expected standardized prevalence rates. The process-based and clinical outcomes (quality targets) will be defined using established methods.  
This proposal cuts across the major research priorities of the SPOR PIHCIN across the three provinces in partnership. The work described here will provide a  platform for timely and efficient access to specialist care for those in need by identifying high risk CKD populations requiring specialist input to care, and channeling those into existing platforms such as the CKD pathway for primary care and the electronic referral and consultation (eConsult) system. It will enhance the primary care and specialists’ collaborations and interactions for efficient and timely nephrology care for those who need it, and thereby reduce wait times, and improve process of care and related outcomes. Second, it targeted the high risk vulnerable population with CKD (often with multiple co-morbidities), and this will create a platform to improve health outcomes for this high risk group in the communities. The surveillance mechanism once developed will facilitate identification and appropriate management of CKD patients at high risk of progression to ESRD and has the potential to reduce significantly the number of CKD patients that start dialysis without receiving pre-dialysis care. This project will demonstrate proof of concept for a new model of care delivery, and may provide the basis for developing relevant policies and KT strategies to enhance the uptake of findings –to people with CKD as well as other chronic diseases. 

The Alberta SPOR PIHCIN will provide support for this project in the following areas:

  • Access to networking support in Alberta and nationally through the SPOR PIHCIN network of networks;
  • Methodology development support through the Alberta SPOR PIHCIN Coordinator and Tripartite Leads; 
  • Provide patient feedback on the LOI that was submitted in development of the grant proposal;
  • Facilitate any requested expertise from the seven Alberta SPOR SUPPORT Unit Platforms to ensure that integration from research into care has a significant positive impact for patients and the health care system. 

Conference presentation: (to be updated)

Publication: (to be updated)

Contact information:

Dr. Aminu Bello
University of Alberta
11-107 Clinical Sciences