The role of specialists in managing the health of populations with chronic illness: the example of chronic kidney disease

doi:10.1136/bmj.b2395

Published 8 July 2009, doi:10.1136/bmj.b2395
Cite this as: BMJ 2009;339:b2395

Practice

Quality Improvement Report

The role of specialists in managing the health of populations with chronic illness: the example of chronic kidney disease

Brian J Lee, nephrologist¹, Ken Forbes, care management analyst²

¹ Kaiser Permanente, Hawaii Region, Moanalua Medical Center, 3288 Moanalua Rd, Honolulu, HI 96819, USA, ² Kaiser Permanente, Hawaii Region, Care Management Institute, 2828 Paa Street, Honolulu, HI 96819

Correspondence to: B J Lee brian.j.lee@kp.org

The first 150 words of the full text of this article appear below.

Abstract

Problem Specialty care has been used to manage individualpatients at the discretion of generalists but not to drive improvementsat the population level.

Design Observational longitudinalstudy.

Setting Kaiser Permanente Hawaii, with more than 10000 members with documented chronic kidney disease.

Key measuresfor improvement Rate of late referrals to nephrology care, definedas occurring within four months of end stage renal disease andthe proportions of patients starting haemodialysis with a maturearteriovenous fistula and starting dialysis in the outpatientsetting.

Strategies for change Risk stratification of the entirepopulation and unsolicited consultations provided by nephrologiststo generalists, based on patients’ risk level, enabledby an electronic population management database.

Effects ofchange Between 2004 and 2008, the proportion of referrals occurringwithin four months of onset of end stage renal disease droppedfrom 37 of 116 (32%) to 10 of 84 (12%), P=0.001. The proportion. . . [Full text of this article]

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Article

Patients first: Trish Groves
BMJ 2009 339: b4010. [Extract] [Full Text]

Rapid Responses:

Read all Rapid Responses

The role of specialists, information systems and an evidence-based approach in managing the health of populations with chronic illness: Michael E. Stuart, et al.
bmj.com, 10 Jul 2009 [Full text]