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Donald M, Smekal MD, Elliott MJ, et al. Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study. BMC Nephrol. 2021;22(1):332doi: 10.1186/s12882-021-02533-5.
Donald, M., Smekal, M. D., Elliott, M. J., McBrien, K., Weaver, R. G., Manns, B. J., Tonelli, M., Bello, A., Straus, S. E., Scott-Douglas, N., Jindal, K., & Hemmelgarn, B. R. (2021). Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study. BMC nephrology, 22(1), 332. https://doi.org/10.1186/s12882-021-02533-5
Donald, Maoliosa, et al. "Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study." BMC nephrology vol. 22,1 (2021): 332. doi: https://doi.org/10.1186/s12882-021-02533-5
Donald M, Smekal MD, Elliott MJ, McBrien K, Weaver RG, Manns BJ, Tonelli M, Bello A, Straus SE, Scott-Douglas N, Jindal K, Hemmelgarn BR. Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study. BMC Nephrol. 2021 Oct 06;22(1):332. doi: 10.1186/s12882-021-02533-5. PMID: 34615462; PMCID: PMC8496057.
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BMC Nephrol. 2021 Oct 06;22(1):332. doi: 10.1186/s12882-021-02533-5.

Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study.

BMC nephrology

Maoliosa Donald, Michelle D Smekal, Meghan J Elliott, Kerry McBrien, Robert G Weaver, Braden J Manns, Marcello Tonelli, Aminu Bello, Sharon E Straus, Nairne Scott-Douglas, Kailash Jindal, Brenda R Hemmelgarn

Affiliations

  1. Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
  2. Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
  3. Faculty of Medicine & Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Clinical Sciences Building, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
  4. Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.
  5. Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. [email protected].
  6. Faculty of Medicine & Dentistry, University of Alberta, 2J2.01 Walter C MacKenzie Health Sciences Centre, Clinical Sciences Building, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada. [email protected].

PMID: 34615462 PMCID: PMC8496057 DOI: 10.1186/s12882-021-02533-5

Abstract

BACKGROUND: Clinical pathways aim to improve patient care. We sought to determine whether an online chronic kidney disease (CKD) clinical pathway was associated with improvements in CKD management.

METHODS: We conducted a retrospective pre/post population-based cohort study using linked health data from Alberta, Canada. We included adults 18 years or older with mean estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m

RESULTS: The study period spanned October 2010 to March 2017. There were 84 independent 28-day periods (53 pre, 31 post pathway implementation) including 345,058 adults. The population was predominantly female (56%) with median age 77 years; most had category 3A CKD (67%) and hypertension (82%). In adjusted segmented regression models, the increase in the rate of change of ACR testing was greatest in Calgary zone (adjusted OR 1.19 per year, 95% CI 1.16-1.21), where dissemination of the pathway was strongest; this increase was more pronounced in those without diabetes (adjusted OR 1.25 per year, 95% CI 1.21-1.29). Small improvements in guideline-concordant medication use were also observed.

CONCLUSIONS: Following implementation of an online CKD clinical pathway, improvements in ACR testing were evident in regions where the pathway was most actively used, particularly among individuals without diabetes.

© 2021. The Author(s).

Keywords: Chronic kidney disease; Clinical pathway; Knowledge translation; Primary care; Quality improvement

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