Reducing Unnecessary Imaging in Children With Multicystic Dysplastic Kidney or Solitary Kidney

Abstract

BACKGROUND AND OBJECTIVES Children with isolated unilateral multicystic dysplastic kidney (MCDK) or congenital solitary kidney (CSK) undergo serial renal ultrasonography with variable frequency until they are transitioned to adult care. A growing body of literature suggests the value of frequent ultrasonography in this population is limited, providing no benefit to overall outcomes. Despite emerging evidence, ultrasound remains overused, resulting in avoidable health care expenditures and unnecessary use of resources. With our initiative, we aimed to improve quality of care by reducing avoidable ultrasounds in these children. METHODS This was a single-center, prospective, interrupted time series of children <18 years with ultrasound-confirmed isolated unilateral MCDK or CSK in the outpatient nephrology clinic to evaluate the effect of a decision-making algorithm on the proportion of children receiving an avoidable ultrasound. An algorithm depicting a consensus, evidence-based protocol for managing pediatric MCDK or CSK was refined through content expert feedback and usability testing to standardize frequency of ultrasonography. Ultrasounds were deemed necessary after birth, at 6 months, and at 2, 5, 10, and 15 years. Differences pre- and postintervention were determined by using a U chart and t and F tests for significance. RESULTS The algorithm resulted in a 47% reduction (P < .001) in the proportion of avoidable ultrasounds ordered in children with MCDK and CSK. This reduction was sustainable over a 6-month period and would result in at least $46 000 annual savings. CONCLUSIONS Introduction of a clinical decision-making algorithm was associated with a reduction in avoidable ultrasound testing. Improving adherence across providers may allow for an even more pronounced reduction.

Early Renal Ultrasound in Patients with Congenital Solitary Kidney Can Guide Follow-Up Strategy Reducing Costs While Keeping Long-Term Prognostic Information

“…Recently, Jawa et al showed that he development of a specific algorithm could reduce by 47% the proportion of avoidable ultrasounds ordered in CSFK children resulting in about $46,000 of annual savings [10]. Our cost analysis showed that ERUSA could further reduce the costs when applied to the analyzed follow-up protocols without missing long-term important prognostic information (Table 4).…”

“…To identify earlyin-life predictors of absence of KI in adulthood could be useful in personalizing follow-up protocols of CSFK children in order to reduce unnecessary medicalization with impact on stressful procedures (such as blood sample collection in children) and economic costs. We also estimated the cost saving of integrating the current follow-up protocols [2,10] with the early RUS algorithm (ERUSA) (secondary outcome). The ERUSA is based on the hypothesis that early RUS could provide the instruments to personalize follow-up.…”

“…The direct costs that would have been incurred for the different follow-up protocols [2,10] were calculated. The costing consisted of the reimbursement of Italian Health System: RUS (€82) [20], blood sample collection (€2.58), creatinine dosage (€1.13), urinalysis (€2.17), follow-up visit (€20.66) [21].…”

“…We estimated the costs sustained according with the old approach adopted in our clinic, with the approach suggested by Groen in 't Woud et al [2] and that suggested by Jawa et al [10], as well as the cost saving created by applying ERUSA to each followup protocol.…”

“…The economic costs of the different follow-up protocols applied to CSFK children are shown in the Table 4 and ranged from €117,874 with our old approach to €55,860 with the Jawa et al approach [10]. Among all the protocols, the highest direct costs were related to RUS (costs range: €55,104-€22,960).…”