Ontario Renal Network | Reseau Renal de L'Ontario
 

Our Progress So Far


ORN | Ontario Renal Network » Ontario Renal Plan » Our Progress So Far
 
Marci O.
“If you haven’t lived with CKD, you have no idea what it is really like to face this disease. That’s why it is so important to include patients and their families in planning kidney care services.”Marci's Story All Stories

Our first Ontario Renal Plan (2012 – 2015) focused on accountability to patients, early detection and prevention of progression, independent dialysis and vascular access, infrastructure, research and innovation, and alignment of funding to quality patient-focused care.Working with our partners, we established a solid foundation on which to build. While we have seen modest improvements in priority areas, we continue our work to improve patient care. Here, we share highlights of our accomplishments.

Accountability to patients

We engaged people with CKD (as well as their families) in a variety of Ontario Renal Network activities, including strategic planning, developing educational materials, and participation in CKD research projects. We assessed how Ontario’s renal programs engage patients and families, and based on what we learned, assisted all Regional Renal Programs in developing comprehensive plans to enhance patient and family engagement.

Early detection and prevention of progression

New clinical tools and resources are helping primary care providers better detect and manage CKD, preserving kidney function and delaying progression of the disease.

  • A newly developed and tested primary care toolkit will enable patients to be referred more appropriately and with relevant information
  • We piloted a mentorship program in 15 of 26 Regional Renal Programs. As it expands, it will give primary care providers even more support for managing patients with CKD.

There has been a decline in sub-optimal dialysis starts—i.e., fewer patients who had been in 12 months or more of pre-dialysis care had to start dialysis as an in-patient and/or with an unplanned temporary hemodialysis catheter. As of the first quarter of 2014/15, sub-optimal starts decreased more than 10% compared with the first quarter of 2012/13.

Independent dialysis and vascular access

Each Regional Renal Program now has Independent Dialysis and Body Access Coordinators to facilitate patient education and assessment for home dialysis and appropriate body access. These coordinators participated in a province-wide quality improvement collaborative to facilitate improvements in the uptake of independent dialysis and appropriate body access.

Other improvements included:
  • A successful pilot project to have personal support workers assist patients with home hemodialysis.
  • A new milestone-tracking tool that helps us better understand barriers to independent dialysis and appropriate body access.
  • Improved wait-times reporting to identify gaps in vascular access, surgical and interventional radiology capacity, and performance.

More people receiving dialysis at home

By 2015, almost 80% of patients were receiving dialysis in the location and method of their choice within 3 months. The percentage of people dialyzing at home increased by 1.5% over 3 years. While this growth may appear modest, it represents an additional 325 people dialyzing at home, enjoying better quality of life and independence.

Fewer patients starting dialysis with a catheter

In addition, hemodialysis catheter use has decreased to 56.0% in 2013 from 56.2% in 2012. While this represents a decrease of less than 1%, other recent data indicate that fewer patients are starting dialysis with a catheter (73% in the first quarter of 2014/15, compared with 79% in the first quarter of 2012/13), which reduces the risk of hemodialysis catheter-related complications for patients.

Infrastructure

We have improved our ability to make available resources and infrastructure for kidney care. We developed a new tool to forecast patients’ needs and hemodialysis station requirements across the province. This tool lets us identify capacity shortages and make transparent, evidence-based decisions about short- and long-term capital and operating investments, ensuring patients have service when they need it. Between 2012 and 2015, more than 100 in-centre hemodialysis dialysis stations were added to the kidney care system.

The Ontario Renal Reporting System was established through the collaboration and efforts of the Regional Renal Programs. This system captures comparable data about all pre-dialysis, acute dialysis and chronic dialysis patients in the province, providing essential information to improve system quality, performance, planning and funding allocation.

Research and innovation

Several key initiatives focused on collaboration with research institutions to translate research into innovation in the field. For example:

  • A collaboration with the Institute for Clinical Evaluative Sciences and Toronto Health Economics and Technology Assessment will enhance analytic capacity and make better use of provincial data.
  • The international Dialysis Outcomes and Practice Patterns Study expanded to 20 dialysis facilities, providing a more comprehensive view of hemodialysis facility performance.

Funding

As part of the provincial government’s Health System Funding Reform initiative, the Chronic Kidney Disease Patient-Based Funding Framework was introduced in all hospital CKD programs in 2012/13. This funding framework promotes patient-centred and evidence-based care, links funding to patients and best care practices, and ensures equity across service providers.

In 2014/15, the framework expanded to incorporate funding for assisted peritoneal dialysis services at Community Care Access Centres and long-term care homes. This expansion supports the shift from hospital-based dialysis to home and community-based care.