East London Community Kidney Service Sally Hull, Neil Ashman, Sec - - PowerPoint PPT Presentation

East London Community Kidney Service

Sally Hull, Neil Ashman, Sec Hoong, Nicola Thomas, Helen Rainey

April 2017

What is the Problem?

Fast rising ESRD rates in East London – ever more people needing dialysis Haemodialysis rates per million population, 3 East London Boroughs 200 300 400 500 600 700 2008 2009 2010 2011 2012 2013 Haemodialysis/million population

NHS City and Hackney NHS Newham NHS Tower Hamlets England

Data from the UK Renal Registry 2015

What are we doing about this?

• 1. Community CKD eClinic

Community-based Nephrologist doing e-clinic in EMIS Web Referrals ALL electronic (through e-referral)- unless urgent All reviews and opinions recorded in EMIS Web Locally relevant guidelines.

E-referrals and local guidelines

• 3. Community CKD overview

CKD Prevalence searches to find un-coded patients CCG/Practice dashboards with KPIs ‘Trigger tools’ to alert GPs to patients with a falling eGFR

Practice safety alerts Community based education Find and code cases

• 2. Practitioner and Patient education

Practice based education for clinicians Patient one-on-one and group education

Community CKD eClinic

Who to refer to the community renal clinic? everyone previously referred to outpatients. How to refer to the community renal clinic? Write your question in the patient record. Ask for patient consent to view the record Use the e-referral service When will my patient be “seen”? Next week

Patient consent for shared record

GP opens shared record Nephrology

• pinion

visible in GP record

Change in clinic activity: Tower Hamlets 2015/6

10 20 30 40 50 60 70 80 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

First appointments to vCKD and Nephrology: Tower Hamlets CCG 2015/6

FA General nephrology vCKD

About 20% of patients require a face to face appointment Clinic Outcomes 2016 No. % OP F2F Appointment 111 21.5 Discharge to GP 255 50 Review in vCKD 143 27.5 Other 5 1 Total 514 100

Waiting times for consultant advice slashed!

• In the six-week pilot period 19/35 practices referred into the community e-

clinic.

• Over 70% of referrals are managed without the need for patients to attend a

hospital appointment.

• During 2015 the average wait for a renal clinic appointment was 64 days. Using

the e-clinic the average time to get nephrology advice is 5 days.

Consultants say… We can provide comprehensive management advice whilst avoiding unnecessary duplication

• f tests.

GPs say… A model for future care happening right now in Tower Hamlets!

Early Wins for the service

CKD practice tools

CKD Prevalence searches to find un-coded patients CCG/Practice dashboards with KPIs ‘Trigger tools’ to alert GPs to patients with a falling eGFR

Community CKD surveillance

CKD Prevalence searches

CKD

Prevalence searches

period Annual review code but not on CKD register ever eGFR 1-29 but not on CKD register last two years eGFR 30-44 but not on CKD register last two years Renal codes but not on CKD register ever 8A6.. Renal function monitoring 6AA.. Chronic kidney disease annual review 66i.. Chronic kidney disease monitoring 1Z1.. Chronic renal impairment (exclude child codes) 7B00. Transplantation of kidney ZV420 [V]Kidney transplanted 7L1A0 Renal dialysis K0... Nephritis, nephrosis and nephrotic syndrome

East London CKD Dashboard – Jan 2017

(21,560 CKD cases) METRIC CCG 1 CCG 2 CCG 3 CCG 4

• 1. Proportion of CKD cases coded

87% 80% 54% 49%

• 2. Proportion of CKD cases, with

diabetes, coded 88% 83% 59% 60%

• 3. CKD with BP below 140/90

74% 71% 64% 55%

• 4. CKD and diabetes, with BP

below 130/80 43% 39% 36% 31%

• 5. Adults with CKD on lipid-

lowering medication 80% 76% 73% 64%

Improvements to CKD coding 2016-7

Practice List size Patients aged 18+ Adults with eGFR evidence of CKD

Metric 1

eGFR evidence of CKD - and CKD Read code Rate Adults with eGFR evidence of CKD with diabetes

Metric 2

eGFR evidence

• f CKD, Diabetes

and CKD Read code Rate

Min 15.6% 17.9% Max 93.7% 96.4%

F84004 12,238 8773 342 236 69.0% 122 87 71.3% F84006 12,630 9537 297 164 55.2% 155 87 56.1% F84009 9,114 7407 140 99 70.7% 63 47 74.6% F84010 10,165 7874 255 144 56.5% 99 54 54.5% F84014 7,575 5741 200 152 76.0% 125 98 78.4% F84017 13,731 10365 274 222 81.0% 123 105 85.4% F84022 6,389 5317 119 79 66.4% 50 34 68.0% F84032 3,006 2223 49 21 42.9% 26 14 53.8% F84047 11,713 8472 239 146 61.1% 78 47 60.3% F84050 9,318 6522 122 55 45.1% 67 29 43.3% F84052 8,660 6734 198 44 22.2% 77 18 23.4% F84053 7,568 5801 155 51 32.9% 68 24 35.3% F84070 4,807 3751 146 53 36.3% 72 30 41.7% F84074 10,145 7701 287 214 74.6% 124 97 78.2% F84077 7,693 6280 142 99 69.7% 54 43 79.6%

Practice ‘trigger’ tools

CKD managed in a single care record Coding improved to prevent medicines errors and enable CKD monitoring Trigger tools to ‘find’ unknown at risk patients Patient self-management through education & information

East London Community Kidney Service