Evaluating the Implementation Strategy for Estimated Glomerular Filtration Rate Reporting in Manitoba: The Effect on Referral Numbers, Wait Times, and Appropriateness of Consults

Hingwala, Jay; Bhangoo, S; Hiebert, Brett; Sood, Manish M.; Rigatto, Claudio; Tangri, Navdeep; Komenda, Paul

doi:10.1186/2054-3581-1-9

Cited by 10 publications

(11 citation statements)

References 35 publications

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“…8,[10][11][12] Our own experience with automatic eGFR reporting suggested a large increase in low-risk referrals who did not meet prespecified criteria for nephrology care. 13 In 2011, the Kidney Failure Risk Equation (KFRE) was developed and has subsequently been shown to be highly accurate in predicting the progression of CKD to kidney failure. 14 Since that time, the KFRE has been extensively validated in multiple diverse CKD populations worldwide.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation

Hingwala

Wojciechowski

Hiebert

et al. 2017

Can J Kidney Health Dis

Self Cite

112

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Background:In some jurisdictions, routine reporting of the estimated glomerular filtration rate (eGFR) has led to an increase in nephrology referrals and wait times.Objective:We describe the use of the Kidney Failure Risk Equation (KFRE) as part of a triage process for new nephrology referrals for patients with chronic kidney disease stages 3 to 5 in a Canadian province.Design:A quasi-experimental study design was used.Setting:This study took place in Manitoba, Canada.Measurements:Demographics, laboratory values, referral numbers, and wait times were compared between periods.Methods:In 2012, we adopted a risk-based cutoff of 3% over 5 years using the KFRE as a threshold for triage of new referrals. Referrals who did not meet other prespecified criteria (such as pregnancy, suspected glomerulonephritis, etc) and had a kidney failure risk of <3% over 5 years were returned to primary care with recommendations based on diabetes and hypertension guidelines. The average wait time and number of consults seen between the pretriage (January 1, 2011, to December 31, 2011) and posttriage period (January 1, 2013, to December 31, 2013) were compared using a general linear model.Results:In the pretriage period, the median number of referrals was 68/month (range: 44-76); this increased to 94/month (range: 61-147) in the posttriage period. In the posttriage period, 35% of referrals were booked as urgent, 31% as nonurgent, and 34% of referrals were not booked. The median wait times improved from 230 days (range: 126-355) in the pretriage period to 58 days (range: 48-69) in the posttriage period.Limitations:We do not have long-term follow-up on patients triaged as low risk. Our study may not be applicable to nephrology teams operating under capacity without wait lists. We did not collect detailed information on all referrals in the pretriage period, so any differences in our pretriage and posttriage patient groups may be unaccounted for.Conclusions:Our risk-based triage scheme is an effective health policy tool that led to improved wait times and access to care for patients at highest risk of progression to kidney failure.

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Section: Introductionmentioning

confidence: 99%

“…8,10-12 Our own experience with automatic eGFR reporting suggested a large increase in low-risk referrals who did not meet prespecified criteria for nephrology care. 13…”

Section: Introductionmentioning

confidence: 99%

Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation

Hingwala

Wojciechowski

Hiebert

et al. 2017

Can J Kidney Health Dis

Self Cite

112

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“… 4 In Manitoba, the introduction of estimated glomerular filtration rate (eGFR) reporting increased the number of nephrology referrals (63% of which were inappropriate based on guidelines), and increased non-urgent referral wait times by 40 days. 5 Coordination of care between PCPs and nephrologists is thus essential to effectively manage CKD.…”

Section: Introductionmentioning

confidence: 99%

Nephrology eConsults for Primary Care Providers: Original Investigation

Keely

Magner

et al. 2018

Can J Kidney Health Dis

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Background:The Champlain BASE™ (Building Access to Specialists through eConsultation) eConsult service allows primary care providers (PCPs) to submit patient-specific clinical questions to specialists via a secure web service.Objective:Our objective was to describe the types of nephrology questions asked through an eConsult service based in eastern Ontario and assess the service’s impact on the need for face-to-face consultations.Design:Cross-sectional study using descriptive statistics was conducted using nephrology cases submitted between May 2011 and January 2015. Specialist response times and referral avoidance were collected. Validated taxonomies were used to categorize cases based on question type and content.Setting:Patient cases were collected from PCPs in Ottawa, Ontario, and its surrounding communities and submitted to nephrologists at the Ottawa Hospital.Patients:During the study period, 155 eConsults were submitted to nephrology.Measurement:Utilization and survey data were collected for all eConsults. Questions were categorized by subject matter and question type.Results:A traditional consult visit was avoided in 45% of cases based on the specialist’s advice; 21% cases required referral. Thirty-two percent of eConsults took specialists less than 10 minutes to complete, 55% took 10 to 15 minutes, 11% took 15 to 20 minutes, and only 2% took more than 20 minutes. Twenty-five percent of cases were related to proteinuria, 18% to chronic kidney disease (CKD), 17% to imaging, and 12% to drug use in CKD. Common question types included general management (37%), interpretation of laboratory test (17%), interpretation of an image report (13%), and need for nephrology referral (11%).Limitations:Some consults contained multiple categories and question types. Our analyses required a single classification, which may underestimate the number of questions in each category. Our study had a small sample size using cases completed in a single health jurisdiction, limiting generalizability.Conclusions:The Champlain BASE™ eConsult service provided guidance to PCPs and reduced the number of face-to-face nephrology consultations.

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“…A number of studies have examined the characteristics of primary care referrals to nephrology, including the appropriateness of referrals 18–22. In many of these studies, the introduction of automated eGFR has led to an increased volume of referrals, many deemed perhaps unnecessary.…”

Section: Discussionmentioning

confidence: 99%

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

et al. 2020

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ObjectivesChronic kidney disease (CKD) is common; therefore, coordination of care between primary care and nephrology is important. Ontario Renal Network’s KidneyWise toolkit was developed to provide guidance on the detection and management of people with CKD in primary care (www.kidneywise.ca). The aim of this study was to evaluate the impact of the April 2015 KidneyWise toolkit release on the characteristics of primary care referrals to nephrology.Design and settingThe study was a prospective pre-post design conducted at two nephrology sites (community site: Trillium Health Partners in Mississauga, Ontario, Canada, and academic site: St Joseph’s Healthcare in Hamilton, Ontario, Canada). Referrals were compared during the 3-month time period immediately prior to, and during a 3-month period 1 year after, the toolkit release.Primary and secondary outcome measuresThe primary outcome was the change in proportion of referrals for CKD that met the KidneyWise criteria. Additional secondary referral and quality of care outcomes were also evaluated. Multivariable logistic regression was used to evaluate preselected variables for their independent association with referrals that met the KidneyWise criteria.ResultsThe proportion of referrals for CKD among people who met the KidneyWise referral criteria did not significantly change from pre-KidneyWise to post-KidneyWise implementation (44.7% vs 45.8%, respectively, adjusted OR 1.16, 95% CI 0.85 to 1.59, p=0.36). The proportion of referrals for CKD that provided a urine albumin-creatinine ratio significantly increased post-KidneyWise (25.8% vs 43.8%, adjusted OR 1.45, 95% CI 1.06 to 1.97, p=0.02). The significant independent predictors of meeting the KidneyWise referral criteria were academic site, increased age and use of the KidneyWise referral form.ConclusionsWe did not observe any change in the proportion of appropriate referrals for CKD at two large nephrology centres 1 year after implementation of the KidneyWise toolkit.

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Evaluating the Implementation Strategy for Estimated Glomerular Filtration Rate Reporting in Manitoba: The Effect on Referral Numbers, Wait Times, and Appropriateness of Consults

Cited by 10 publications

References 35 publications

Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation

Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation

Nephrology eConsults for Primary Care Providers: Original Investigation

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

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