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 700 Haemodialysis/million population NHS City and Hackney 600 NHS Newham 500 NHS Tower Hamlets 400 England 300 200 2008 2009 2010 2011 2012 2013 Data from the UK Renal Registry 2015

What are we doing about this? E-referrals 1. Community CKD eClinic and local Community-based Nephrologist doing e-clinic in EMIS Web guidelines Referrals ALL electronic (through e-referral)- unless urgent All reviews and opinions recorded in EMIS Web Locally relevant guidelines. Community 2. Practitioner and Patient education based education Practice based education for clinicians Patient one-on-one and group education Find and code cases 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 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

Nephrology GP opens opinion shared record visible in GP record

Change in clinic activity: Tower Hamlets 2015/6 About 20% of patients require First appointments to vCKD and Nephrology: a face to face Tower Hamlets CCG 2015/6 appointment 80 70 60 50 40 30 20 10 0 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 Clinic Outcomes 2016 No. % OP F2F Appointment 111 21.5 FA General nephrology vCKD Discharge to GP 255 50 Review in vCKD 143 27.5 Other 5 1 Total 514 100

Early Wins for the service 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 . GPs say… Consultants say… A model for future care We can provide comprehensive happening right now in management advice whilst Tower Hamlets! avoiding unnecessary duplication of tests.

Community CKD surveillance 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

CKD Prevalence searches Prevalence searches CKD 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 88% 83% 59% 60% diabetes, coded 3. CKD with BP below 140/90 74% 71% 64% 55% 4. CKD and diabetes, with BP 43% 39% 36% 31% below 130/80 5. Adults with CKD on lipid- 80% 76% 73% 64% lowering medication

Improvements to CKD coding 2016-7 Metric 2 Adults with Metric 1 Adults with eGFR eGFR evidence Patients eGFR eGFR evidence of Practice List size Rate evidence of Rate of CKD, Diabetes aged 18+ evidence of CKD - and CKD CKD with and CKD Read CKD Read code diabetes code Min 15.6% 17.9% Max 93.7% 96.4% F84004 12,238 8773 342 236 69.0% 122 87 71.3% 12,630 297 F84006 9537 164 55.2% 155 87 56.1% 9,114 140 F84009 7407 99 70.7% 63 47 74.6% 10,165 255 F84010 7874 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% 7,693 F84077 6280 142 99 69.7% 54 43 79.6%

Practice ‘trigger’ tools

East London Community Kidney Service 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