BC Kidney Days 2017 Provincial Update
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1 BC Kidney Days 2017 Provincial Update Dr. Adeera Levin MD FRCPC CM Executive Director, BC Renal Agency Professor of Medicine UBC
2 Overview Kidney Disease in BC BC s Model is Unique Nationally and Internationally Structure and function Highlights and accomplishments Strategic priorities Congratulations and New Faces Celebrating 20 years!
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4 Form follows function Patients at centre of org chart Health authorities responsible for program delivery BCPRA provides overarching support for programs and is accountable to PHSA & MOH for outcomes
5 For 20 years, PROMIS has facilitated care and tracked patients on their journey through renal and (more recently) transplant care. How many patient journeys are recorded in PROMIS? a. 40,000 b. 80,000 c. 120,000 d. 160,000
6 10-year Overview
7 10-year Overview
8 Provincial Committee Structure Multidisciplinary committees Cross-HA representation Annual work plans with clear deliverables Research, evaluation and CQI
9 The BCPRA website has new symptom management tools (for patients and care providers) on: a. Pruritus and Restless Leg Syndrome b. Constipation and Muscle Cramps c. Nausea and Fatigue d. All of the above
10 Provincial Committee Highlights: Multi-committee Collaborations Systematic symptom assessment My symptom checklist (modified ESAS) Protocols and symptom guides Companion patient teaching handouts Pharmacy information sheets Evaluation indicators Provincial dialysis access working group for timely access creation (HD/PD) TB screening new dialysis patients (First in Canada) In final stages of development: transition algorithms for all modalities, incl. transplant, and corresponding patient guides
11 Provincial Committee Highlights: Kidney Care Committee Transplant First Initiative (collaboration with BC Transplant) New formulary for non-dialysis KCC patients with egfr <15 (collaboration with Pharmacy Formulary Committee and Palliative Care Committee) Monthly online KCC staff education series
12 Provincial Committee Highlights Home Hemodialysis Committee Provincial rollout of NxStage machine completed Staff and patient training Development of protocols and resources for care teams and patients Travel policy for NxStage patients Updating HHD tools to support evidenceinformed practice Guidelines HHD patient workbook Developing quality indicators PROMIS updates
13 Thirty percent of patients on PD need temporary HD in any given year. What percentage of these patients end up staying on HD permanently? a. 30% b. 50% c. 70% d. 90%
14 Provincial Committee Highlights Peritoneal Dialysis Committee PD Assist provincial rollout (completion Dec 17) published articles in two international journals 2017 Excellence in Quality Award BC Patient Safety Quality Council Sponsorship of PD nurses for BCIT online advanced PD course (developed with BCPRA) Standardized nursing procedures Western Canada PD Days presentations archived on website Trialing new PD cyclers across BC
15 Provincial Committee Highlights Hemodialysis Committee Implemented updated acuity scale time/motion analysis in several units Developed and revised a range of guidelines and patient teaching tools Developed indicator report to guide improvements in care Provincial contract management
16 In a BCPRA-sponsored survey of nephrologists across Canada, what percentage said they always or often discuss expected survival with their patients on dialysis? a. 10% b. 19% c. 44% d. >50%
17 Provincial Committee Highlights Palliative Care Committee Two prognostication studies published Palliative Medicine Canadian Journal of Kidney Health and Disease Developed renal palliative quality data indicators Supporting ACP and ESAS across programs Enhanced palliative care section on BCPRA website, including Medical Assistance in Dying (MAiD) resources First BC Palliative nephrology fellowship Dr. Morgan Lam
18 Provincial Committee Highlights Pharmacy & Formulary Committee New community pharmacy contracts 33 community pharmacy partners providing closer-to-home service Updated and new symptom management algorithms and patient teaching tools Updated dialysis formulary Evidence-based review for symptom management Deleted select therapies not supported by evidence New formulary for non-dialysis patients with advanced CKD (egfr <15 ml/min)
19 Provincial Committee Highlights Glomerulonephritis (GN) Committee GN Registry Developing annual report to evaluate patterns of care and outcomes GN Formulary Medication adjudication Lit reviews; pre-printed orders and protocols Conversion to generic tacrolimus Knowledge translation Province-wide rounds KCC education Establishing GN Fellowship (July 2018)
20 Provincial Committee Highlights Emergency Response To the IH and NH Renal Programs! Renal Emergency Management Committee: Maintenance and implementation of provincial renal emergency response plans Ongoing promotion and education: Emergency prep month May
21 Other Highlights: Public Outreach World Kidney Day/Kidney Smart Campaigns Social media Facebook advertising #KidneyHealthChallenge Advertising: Van Sun/Province, public transit, ethnic media WKD promotion Day at Dialysis social media event
22 Strategic Priorities Theme #1 Infrastructure: Tech, Facilities, Finance PROMIS Multi-year application road map Proactive facilities and equipment planning Fiscal responsibility: funding model, contracts Theme #2 Outstanding Clinical Care Patient-centred philosophy: PREMs and PROMs Focus on transitions in care Strategic framework to address expensive new medications Telehealth: Indigenous and rural communities
23 Strategic Priorities Theme #3 Enhancing the Mandate GN Network PKD Initiative Exploring synergies across disease groups Theme #4 Research, Knowledge Translation, Education Leverage research and knowledge transfer to foster change Ongoing educational opportunities for care teams CKD education for primary care
24 Regional Innovations Multiple quality improvement initiatives across HA programs: Funded through value add $$ (see handouts and BCKD app) Posters at BCKD > For Health Professionals > Research
25 Sustainability and renewal: People PRA and UBC supported Advanced Training Fellowships Clinical Fellowships - support of UBC training program Judy Graham ANT/Home therapies (HT) Melissa Nataatmadja ANT/HT Anoushka Krishnan - ANT Jun Suh ANT Post Doctoral Fellowships Elizabeth Lee Provincial HD Fellowship Morgan Lam Provincial Palliative Care Fellowship Administrative Fellowship Mike Bevilacqua (completed July 2017) Robert Wood Johnson Award
26 Welcome Adult Nephrology Core Training Neph Fellows - Peter Birks (Y2) - Kris Poinen (Y2) - Arenn Jauhal (Y2) - Justin Gill (Y1) - Abdul Alkandari (Y1) - Priya Jindal (Y1) - Aiza Waheed (Y1) Pediatric Nephrology - Sawsan Al Batati - Jean Koh - Isaac Elias - Pratichi Kadam New Nephrologists - Mike Bevilacqua (FHA)
27 Welcome to Hong Kong colleagues! Collaboration & Knowledge Exchange with Hong Kong Society of Nephrology (HKSN) Today at 10:45 11:15 am Dr. Sydney Tang The Blossoming of PD in Hong Kong Dr. Yuk Lun Cheng Developing a Home Hemodialysis Program in Hong Kong Dr. Bonnie Kwa Professor Richard Yu Dr. Mike Copland & Dr. Suneet Singh presented at HKSN Annual Scientific Meeting Sept 30 th HHD, PD and BC model of kidney care
28 Reflecting on 20 Years! Over 20 years, we ve collectively built a system of kidney care respected & emulated the world over! What we ve achieved together: Reduced dialysis growth (16% per year to low single digits) Delayed disease progression Provincial lab strategy Network of kidney care clinics Highest independent dialysis rates in Canada Most extensive financial support for renal medications in Canada Only province-wide integrated Information system / registry And the list goes on
29 Why it matters? For our patients: Small ways to celebrate our anniversary: Test your knowledge of the BC Renal Agency through the BCKD app!
30 Thank you for your energy & commitment to people living with kidney disease Over 300 people actively involved in our network: All health care team members directly contribute to patient wellness The BCPRA is us, working together
31 Your feedback is important! Use the BCKD app!
32 Enjoy the conference!
33
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