Docstoc

Dialysis_growth_Feb08_LHIN14

Document Sample
Dialysis_growth_Feb08_LHIN14 Powered By Docstoc
					Evidence guiding health care
 Source
•   This report is based on the December 13, 2007,
    presentation by Robert Quinn MD FRCPC to the 14
    Local Health Integration Networks
•   Investigators: Robert R. Quinn MD FRCPC, Janet E.
    Hux MD MHS FRCPC, Michael Paterson MSc, Matthew
    J. Oliver MD MHS FRCPC
•   Statistician: Rahim Moineddin PhD
•   Analysts: Laurence Chong BSc Eng, Cindy Huo MD MSc
•   Acknowledgements:
      Ginette Daigle, MOHLTC

      Kingston Regional Dialysis Program


Evidence guiding health care
Table of Contents

                                               Slides
 •   Background ……………………………..……….. 4 to 11
 •   The First 90 Days of Dialysis Treatment
       Methodology ………………………………..... 12 to 15

       Key Findings – Ontario………………………. 16 to 20

 •   Predicting the Growth in Dialysis Services
       Methodology ………………………………….. 21

       Key Findings – Ontario and LHIN ………….. 22 to 45

 •   Interpretative Cautions ………………………….. 46 to 48
 •   Other Considerations…………………………….. 49
 •   Conclusions ………………………………………. 50


Evidence guiding health care
Background:
How People with Kidney Failure Present
 1. Slowly progressive chronic kidney disease
            Often followed in predialysis clinics
            Usually start as outpatients
 2. Acute kidney injury requiring dialysis
            Develop kidney failure after acute illness
            Hospitalized; high resource utilization; high mortality
             rate; high rate of recovery
 3. Acute kidney injury in setting of chronic kidney disease
            Precipitous decline in kidney function due to acute
             illness
            Usually hospitalized; intermediate mortality and
             likelihood of recovery

Evidence guiding health care
Background:
Treatment Considerations

  •   Transplantation
        Preferred therapy (cheapest; best outcomes)

        Limited supply of organs


  •   Hemodialysis (HD)
        Highest annual operating costs

        Performed in outpatient units (capital investment)


  •   Peritoneal Dialysis (PD)
        Lower annual operating costs vs. HD

        Capital costs minimal

        Home therapy



Evidence guiding health care
Background:
Treatment of Kidney Failure in Canada

 •   Approximately 31,000 patients required renal
     replacement therapy (RRT) in Canada by end of 2004.*
       49% treated with hemodialysis (HD)

       39% alive with a functioning transplant

       12% treated with peritoneal dialysis (PD)




 * Canadian Institute for Health Information, CORR Annual Report, 2006



Evidence guiding health care
Background:
The Cost of Caring for Patients
 •   Caring for patients with kidney failure is resource
     intensive.
       They comprise 0.7% of the Medicare population.

       They consume 5% of the annual Medicare budget.*


 •   The population of patients with kidney failure continues
     to grow.
 •   Projections of the need for dialysis services required
     should also consider equipment, facilities and
     personnel.


 *United States Renal Data System, Annual Report, 2006

Evidence guiding health care
Background:
Terminology and Planning Perspective

•   Incident dialysis patients – All NEW dialysis patients
    during the period of interest

•   Total prevalent patients (acute and chronic) – ALL
    patients receiving dialysis therapy at a given point in time

•   Total prevalent outpatients (hemodialysis and
    peritoneal dialysis) – All patients that are the
    responsibility of an outpatient dialysis unit. You need a
    “spot” for them.




Evidence guiding health care
Background:
Forecasting the Volume of Prevalent Outpatients
on HD or PD

From a planning perspective,
• Need to know modality mix (PD vs. HD) in prevalent
  outpatients in order to plan new HD units (total prevalent
  outpatient HD)

“How many outpatient HD spots do I need?”




Evidence guiding health care
Background:
Limitations of Existing Literature

•   Only include chronic dialysis patients (acute patients
    excluded)
        Based on registry data and do not capture all patients
         because of the “90-day rule”
        Often ignore patients with a history of transient
         dialysis treatment or prior transplant
        Ignore the impact of patients with acute kidney injury
         requiring dialysis which divert resources from the
         chronic population. They make up ~60% of new
         patients but only 3% of the prevalent population.


Evidence guiding health care
 Background:
 Study Objectives
 1. Identify all patients who received dialysis treatment in
       the province between July 1, 1998, and December
       31, 2005.
 2. Describe the disposition of this cohort 90 days
       following the initiation of therapy. This was done to
       capture and not underestimate the resource impact of
       acute and chronic dialysis patients, particularly acute
       patients who may recover or die prior to 90 days.
 3. Use time series analysis to model historical data
       incidence and prevalence data and make projections
       about the need for dialysis services in Ontario and by
       LHIN to 2011.

Evidence guiding health care
Methodology:
Data Sources

•   Registered Persons Database (RPDB) for demographic
    and vital statistics information
•   Ontario Health Insurance Plan (OHIP) physician billing
    claims to identify dialysis patients and to assign
    treatment modality
•   Canadian Institute for Health Information (CIHI) –
    Discharge Abstract Database (DAD) for information on
    hospitalizations and kidney transplantation




Evidence guiding health care
Methodology:
Data Sources (continued)

•   Administrative Health Data
      Collected for purposes other than research

      Already exists; no further expense to collect

      Allows access to information for entire province; can
       highlight regional differences
      Often used to generate surrogate measures for
       variables of interest
      Validation is required to assess accuracy of using
       data to identify dialysis-specific variables
      Time delays




Evidence guiding health care
Methodology:
Data Sources (continued)
•   LHIN 10 (South East)
        Alternative funding arrangement presented a
         challenge because OHIP physician billing claims were
         used to identify dialysis patients and to assign
         treatment modality
        To generate expected values of variables for the time
         period of interest and to make accurate forecasts:
          • Primary clinical data was provided on prevalent
             outpatient HD and PD patients
          • Assumed rate of dialysis in Kingston had a
             constant relationship with the provincial rate
Evidence guiding health care
Methodology:
“The First 90 Days of Dialysis”

•   All patients starting dialysis who received at least one
    treatment were followed for 90 days.

•   The following measures were described:
        distribution of initial treatment modalities
        percentage of patients starting in hospital and
         probability of death before discharge
        percentage of patients requiring outpatient treatment
        disposition 90 days after starting dialysis



Evidence guiding health care
                               Key Findings


                         “The First 90 Days”




Evidence guiding health care
Key Findings:
Initial Form of Dialysis Treatment


                                                 Peritoneal Dialysis
                                                        12%



Hemodialysis
   73%

                                                 Continuous Dialysis
                                                       (CRRT)*
                                                         15%

Based on data from 31,679 patients
* Continuous Renal Replacement Therapy (CRRT) is used almost exclusively
for the treatment of renal failure in critically ill patients.
Evidence guiding health care
Key Findings:
The First 90 Days of Dialysis

•   62% of all new patients start dialysis in hospital
      Risk of death before discharge is 27%



•   63% of all new patients will go on to require treatment in
    an outpatient dialysis facility




Evidence guiding health care
Key Findings:
Status at 90 Days

             Recovered                             Dead
               25%                                 23%




                               Alive on Dialysis
                                     52%


Evidence guiding health care
  Key Findings:
  Summary - The First 90 Days of Dialysis
                                                                       Modality (type) of dialysis treatment that patients received for
                                                                                            their initial treatment*
          Patterns of Dialysis Treatment                                                        Peritoneal              Continuous Renal
                                                                    Hemodialysis
                                                                                                 Dialysis                 Replacement                         Overall
                                                                       (HD)                                                 Therapy
                                                                                                  (PD)
     Distribution of initial modality                                      73%                       12%                           15%                         100%
                                              Recovered                    25%                       12%                           37%                          25%
     All patients
     starting                        Alive on dialysis                     56%                       83%                            8%                          52%
     dialysis: status                                  Dead                20%                        7%                           54%                          23%
     at 90 days
                                                        All**             100%                      100%                          100%                         100%
     Probability a patient starting
     dialysis in hospital will die before                                  20%                       10%                           51%                          27%
     discharge***
                                              In hospital                  61%                       26%                                                        62%
     New patients
     who start HD                         As outpatient                    39%                       74%                                                        38%
     or PD
                                                           All            100%                      100%                                                       100%
     Percentage of HD or PD patients
     who will go on to require outpatient                                  68%                       95%                                                        63%
     dialysis
 Note: Information in this table will help planners and policy makers make decisions about resource allocation.
 * Based on 31,679 incident dialysis patients in Ontario from July 1, 1998 to December 31, 2005. All patients with acute renal failure, acute-on-chronic renal failure, and slowly
   progressive kidney disease that eventually required dialysis were included, regardless of whether they started dialysis in hospital or in the community.
 ** May not add up to 100% due to rounding.
 *** Based on 19,640 incident patients who started dialysis in hospital during study period.
Evidence guiding health care
Methodology:
Predicting the Growth in Dialysis Services

•   The number of patients requiring treatment was
    determined at regularly spaced three-month intervals:
        Total number of incident dialysis patients (acute and
         chronic)
        Total number of prevalent patients (acute and chronic)
        Total number of prevalent outpatients
        Total number of prevalent outpatient HD
        Total number of prevalent outpatient PD
•   Stepwise autoregression was used to model historical
    incidence and prevalence counts and forecast volumes
    to 2011. This model fit the data well with narrow
    confidence intervals.


Evidence guiding health care
                               Key Findings

                Growth in Dialysis Services
                  in Ontario and by LHIN,
                        2007 – 2011




Evidence guiding health care
   Number of prevalent dialysis patients (actual and forecasted),
                  Oct 1998 – Jan 2011, Ontario



         • The number of patients being treated with dialysis
           at any point in time is very predictable and is
           growing in a linear fashion
         • Projected to grow to 11,104 patients by 2011
         • Confidence intervals (10,931-11,277) or +/- 1.6%




Evidence guiding health care
          Number of prevalent dialysis patients (forecasted),
                    Oct 2005 – Jan 2011, Ontario
                         Date       Forecast   Lower Limit   Upper Limit
                       01/10/2005     8516        8405          8628
                       01/01/2006     8666        8544          8789
                       01/04/2006     8794        8668          8919
                       01/07/2006     8902        8774          9030
                       01/10/2006     9024        8895          9153
                       01/01/2007     9177        9046          9308
                       01/04/2007     9319        9187          9451
                       01/07/2007     9436        9302          9570
                       01/10/2007     9535        9399          9670
                       01/01/2008     9652        9510          9793
                       01/04/2008     9762        9615          9909
                       01/07/2008     9877        9726          10027
                       01/10/2008    10000        9848          10153
                       01/01/2009    10124        9969          10278
                       01/04/2009    10236        10079         10392
                       01/07/2009    10346        10188         10505
                       01/10/2009    10465        10305         10625
                       01/01/2010    10594        10432         10756
                       01/04/2010    10721        10557         10886
                       01/07/2010    10851        10683         11018
                       01/10/2010    10979        10809         11149
                       01/01/2011    11104        10931         11277

Evidence guiding health care
  Number of prevalent dialysis patients (actual and forecasted),
                     Oct 1998 – Jan 2011,
                     LHIN 14 (North West)




Evidence guiding health care
          Number of prevalent dialysis patients (forecasted),
             Oct 2005 – Jan 2011, LHIN 14 (North West)

                       Date       Forecast   Lower Limit   Upper Limit
                     01/10/2005     198          186           210
                     01/01/2006     202          188           217
                     01/04/2006     206          191           222
                     01/07/2006     210          194           226
                     01/10/2006     214          197           230
                     01/01/2007     217          200           234
                     01/04/2007     220          203           237
                     01/07/2007     223          206           240
                     01/10/2007     226          209           244
                     01/01/2008     230          212           247
                     01/04/2008     233          215           250
                     01/07/2008     236          218           254
                     01/10/2008     239          221           257
                     01/01/2009     242          224           260
                     01/04/2009     245          227           263
                     01/07/2009     248          229           266
                     01/10/2009     251          232           270
                     01/01/2010     254          235           273
                     01/04/2010     257          238           276
                     01/07/2010     260          241           279
                     01/10/2010     263          244           283
                     01/01/2011     266          246           286


Evidence guiding health care
       Number of prevalent outpatients (actual and forecasted),
                    Oct 1998 – Jan 2011, Ontario



          • Number of prevalent outpatients being treated with
            dialysis at any point in time is also very predictable
            and is growing in a linear fashion
          • Projected to grow to 10,796 patients by 2011
          • Confidence intervals (10,655 – 10,938) or +/- 1.3%




Evidence guiding health care
             Number of prevalent outpatients (forecasted),
                    Oct 2005 – Jan 2011, Ontario
                        Date       Forecast   Lower Limit   Upper Limit
                      01/10/2005     8249        8158          8339
                      01/01/2006     8371        8273          8469
                      01/04/2006     8497        8397          8597
                      01/07/2006     8639        8538          8741
                      01/10/2006     8746        8639          8853
                      01/01/2007     8878        8767          8989
                      01/04/2007     9022        8908          9135
                      01/07/2007     9153        9038          9268
                      01/10/2007     9256        9140          9373
                      01/01/2008     9382        9263          9501
                      01/04/2008     9512        9391          9633
                      01/07/2008     9638        9515          9760
                      01/10/2008     9747        9623          9870
                      01/01/2009     9868        9743          9994
                      01/04/2009     9988        9859          10117
                      01/07/2009    10102        9970          10233
                      01/10/2009    10211        10078         10344
                      01/01/2010    10333        10197         10468
                      01/04/2010    10451        10314         10588
                      01/07/2010    10565        10426         10703
                      01/10/2010    10676        10536         10816
                      01/01/2011    10796        10655         10938



Evidence guiding health care
     Number of prevalent outpatients (actual and forecasted),
                      Oct 1998 – Jan 2011,
                      LHIN 14 (North West)




Evidence guiding health care
             Number of prevalent outpatients (forecasted),
              Oct 2005 – Jan 2011, LHIN 14 (North West)

                       Date       Forecast   Lower Limit   Upper Limit
                     01/10/2005     192          180           204
                     01/01/2006     197          183           210
                     01/04/2006     201          186           216
                     01/07/2006     204          189           220
                     01/10/2006     208          192           224
                     01/01/2007     211          195           228
                     01/04/2007     215          198           231
                     01/07/2007     218          201           234
                     01/10/2007     221          204           238
                     01/01/2008     224          207           241
                     01/04/2008     227          210           244
                     01/07/2008     230          213           247
                     01/10/2008     233          215           251
                     01/01/2009     236          218           254
                     01/04/2009     239          221           257
                     01/07/2009     242          224           260
                     01/10/2009     245          227           263
                     01/01/2010     248          229           267
                     01/04/2010     251          232           270
                     01/07/2010     254          235           273
                     01/10/2010     257          238           276
                     01/01/2011     260          240           279


Evidence guiding health care
  Number of prevalent hemodialysis (HD) patients on outpatient HD
      (actual and forecasted), Oct 1998 – Jan 2011, Ontario



         • Majority of prevalent patients are on HD so curve
           resembles that of “all prevalent patients” and
           “prevalent outpatients”
         • Projected to grow to 9,157 patients by 2011 (85%
           prevalent outpatients)
         • Confidence intervals (8,999 – 9,316) or +/- 1.7%




Evidence guiding health care
 Number of prevalent hemodialysis (HD) patients on outpatient HD
            (forecasted), Oct 2005 – Jan 2011, Ontario
                       Date       Forecast   Lower Limit   Upper Limit
                     01/10/2005     6827        6727          6927
                     01/01/2006     6955        6837          7073
                     01/04/2006     7077        6951          7202
                     01/07/2006     7194        7064          7324
                     01/10/2006     7309        7176          7441
                     01/01/2007     7421        7287          7555
                     01/04/2007     7532        7396          7667
                     01/07/2007     7642        7505          7779
                     01/10/2007     7751        7613          7889
                     01/01/2008     7860        7720          8000
                     01/04/2008     7969        7828          8110
                     01/07/2008     8077        7935          8219
                     01/10/2008     8185        8041          8329
                     01/01/2009     8293        8148          8439
                     01/04/2009     8401        8254          8548
                     01/07/2009     8509        8361          8658
                     01/10/2009     8617        8467          8767
                     01/01/2010     8725        8574          8877
                     01/04/2010     8833        8680          8987
                     01/07/2010     8941        8786          9096
                     01/10/2010     9049        8892          9206
                     01/01/2011     9157        8999          9316


Evidence guiding health care
  Number of prevalent hemodialysis (HD) patients on outpatient HD
           (actual and forecasted), Oct 1998 – Jan 2011,
                       LHIN 14 (North West)




Evidence guiding health care
Number of prevalent hemodialysis (HD) patients on outpatient HD
   (forecasted), Oct 2005 – Jan 2011, LHIN 14 (North West)

                     Date       Forecast   Lower Limit   Upper Limit
                   01/10/2005     175          163           188
                   01/01/2006     182          167           196
                   01/04/2006     187          172           202
                   01/07/2006     192          176           207
                   01/10/2006     196          180           211
                   01/01/2007     200          184           215
                   01/04/2007     203          187           219
                   01/07/2007     207          191           223
                   01/10/2007     210          194           227
                   01/01/2008     214          198           230
                   01/04/2008     217          201           234
                   01/07/2008     221          204           238
                   01/10/2008     224          208           241
                   01/01/2009     228          211           245
                   01/04/2009     231          214           248
                   01/07/2009     235          217           252
                   01/10/2009     238          221           256
                   01/01/2010     242          224           259
                   01/04/2010     245          227           263
                   01/07/2010     249          230           267
                   01/10/2010     252          234           270
                   01/01/2011     255          237           274


Evidence guiding health care
    Number of prevalent peritoneal dialysis patients (actual and
            forecasted), Oct 1998 – Jan 2011, Ontario



          • PD growth not as predictable, but still allows
            confident forecasts
          • Projected to grow to 1,629 patients by 2011
            (15% of prevalent outpatients)
          • Confidence intervals (1,532 – 1,726) or +/- 5.6%




Evidence guiding health care
    Number of prevalent peritoneal dialysis patients (forecasted),
                   Oct 2005 – Jan 2011, Ontario
                         Date        Forecast   Lower Limit   Upper Limit
                        01/10/2005     1435        1368          1502
                        01/01/2006     1426        1350          1502
                        01/04/2006     1426        1347          1505
                        01/07/2006     1431        1351          1512
                        01/10/2006     1439        1357          1520
                        01/01/2007     1448        1366          1530
                        01/04/2007     1458        1376          1541
                        01/07/2007     1469        1386          1553
                        01/10/2007     1480        1396          1565
                        01/01/2008     1491        1406          1577
                        01/04/2008     1503        1417          1589
                        01/07/2008     1514        1427          1601
                        01/10/2008     1526        1438          1613
                        01/01/2009     1537        1448          1626
                        01/04/2009     1549        1459          1638
                        01/07/2009     1560        1469          1651
                        01/10/2009     1571        1480          1663
                        01/01/2010     1583        1490          1676
                        01/04/2010     1594        1501          1688
                        01/07/2010     1606        1511          1701
                        01/10/2010     1617        1522          1713
                        01/01/2011     1629        1532          1726



Evidence guiding health care
   Number of prevalent peritoneal dialysis patients (actual and
               forecasted), Oct 1998 – Jan 2011,
                     LHIN 14 (North West)




Evidence guiding health care
  Number of prevalent peritoneal dialysis patients (forecasted),
                 Oct 2005 – Jan 2011, LHIN 14
                         Date       Forecast   Lower Limit   Upper Limit
                       01/10/2005      23          16            31
                       01/01/2006      21          12            30
                       01/04/2006      18           8            28
                       01/07/2006      16           6            26
                       01/10/2006      15           5            26
                       01/01/2007      15           4            26
                       01/04/2007      15           5            26
                       01/07/2007      16           5            27
                       01/10/2007      16           5            27
                       01/01/2008      16           4            27
                       01/04/2008      15           4            26
                       01/07/2008      14           3            26
                       01/10/2008      14           2            25
                       01/01/2009      13           1            25
                       01/04/2009      13           1            25
                       01/07/2009      12           0            24
                       01/10/2009      12           0            24
                       01/01/2010      12           0            24
                       01/04/2010      11           0            24
                       01/07/2010      11           0            23
                       01/10/2010      10           0            23
                       01/01/2011      10           0            23


Evidence guiding health care
      Number of incident dialysis patients (actual and forecasted),
                     Oct 1998 – Jan 2011, Ontario



      • Incidence counts are more variable, but
        demonstrate a clear trend
      • Projected to grow to 1,605 patients per quarter by
        2011
      • Confidence intervals (1,415 – 1,795) or +/- 11.8%




Evidence guiding health care
   Number of incident dialysis patients (actual and forecasted),
                  Oct 2005 – Jan 2011, Ontario
                         Date       Forecast   Lower Limit   Upper Limit
                       01/07/2005     1245        1131          1360
                       01/10/2005     1284        1168          1400
                       01/01/2006     1375        1237          1513
                       01/04/2006     1371        1232          1511
                       01/07/2006     1331        1180          1481
                       01/10/2006     1358        1206          1510
                       01/01/2007     1412        1254          1570
                       01/04/2007     1417        1258          1577
                       01/07/2007     1403        1240          1566
                       01/10/2007     1424        1259          1589
                       01/01/2008     1459        1292          1627
                       01/04/2008     1469        1299          1638
                       01/07/2008     1468        1296          1640
                       01/10/2008     1486        1313          1660
                       01/01/2009     1511        1336          1687
                       01/04/2009     1523        1346          1701
                       01/07/2009     1530        1350          1709
                       01/10/2009     1546        1364          1728
                       01/01/2010     1566        1383          1750
                       01/04/2010     1579        1394          1765
                       01/07/2010     1590        1402          1777
                       01/10/2010     1605        1415          1795


Evidence guiding health care
            Percentage of prevalent outpatients treated
                     with PD vs. HD by year
       90
                                            82          83        83        82
              79        79        80
       80

       70

       60

       50
   %




       40

       30
                   21        21        20
       20                                        18          17        17        18


       10

        0
              1999      2000      2001      2002        2003      2004      2005
                                            Year
                                            HD     PD


Evidence guiding health care
Key Findings:
Growth in Dialysis Services – Ontario Summary

•   Historical average annual growth rates:
      Incidence: 4.9%

      Prevalence: 7.2%.


•   By 2010, 4,000 new patients will require outpatient
    dialysis each year.

•   By 2011, nearly 11,000 prevalent outpatients will require
    treatment (85% HD).




Evidence guiding health care
Key Findings:
Accuracy of Ontario Projections

•   Able to make confident forecasts at a provincial level for
    all variables.

•   Forecast of total prevalent dialysis patients in the
    province on Jan 1, 2005:
      Forecasted value (previous report): 8,100

      Actual value: 8,063

      Difference = 37 patients (0.5% absolute error).


•   Short-term projections are very accurate.



Evidence guiding health care
Key Findings:
Consistency of Ontario Projections

•   Change in forecast of total prevalent dialysis patients in
    province on Jan 1, 2010:
      Forecasted value (Last report): 10,605

      Forecasted value (2007 report): 10,594

      Difference = 11 patients (0.1%)



•   Additional year of data has not changed forecasts out to
    2010 to any significant degree.




Evidence guiding health care
Key Findings:
Accuracy of LHIN Projections

•   Confident in Predictions:
      Total prevalent patients, prevalent outpatients

      Total prevalent outpatient HD



•   Less Confident in Predictions:
      “SMALL NUMBERS IN SMALL LHINS”

      Total prevalent PD patients

      Incident patients were not projected at the LHIN level




Evidence guiding health care
Interpretative Cautions:
Validity of Results

•   No gold standard to compare against
•   Compared projections from previous report to observed
    data
•   External validation
      Compared data to most recent CIHI Canadian Organ

       Replacement Register (CORR) report




Evidence guiding health care
Interpretative Cautions


•   Individuals were identified based on where they live, not
    necessarily where they seek dialysis treatment.
•   A number of patients treated at a given program may live
    outside current LHIN boundaries.
•   LHIN-specific numbers may not reflect the practice of
    particular regional programs.
•   Need to confirm the accuracy of administrative data and
    how it can be used most effectively in planning for
    provision of renal services.


Evidence guiding health care
Interpretative Cautions
•   HD patients also include patients that received home-
    based HD therapies which do not impact the required
    number of outpatient dialysis spots. These are:
      Short, Daily HD

      Nocturnal HD

      Home HD


•   Prevalence of home-based HD therapies varies from
    region to region but recent CORR data would suggest
    this accounts for only 5% of HD patients.

•   Need to study the influence of alternative funding
    arrangements and potentially identify alternative sources
    of information

Evidence guiding health care
Other Considerations for Regional Dialysis
Programs
•   Need to consider the impact of a regional dialysis
    program on resource consumption beyond the provision
    of dialysis services. This includes:
        Personnel
        Hospitalization
        Invasive procedures (access-related complications)
           • Interventional radiology and surgical support
        Provision of home care services
        Rehabilitation, long-term care, palliative services
        Support for other services
           • Oncology
           • Cardiac surgery
           • Critical care
Evidence guiding health care
Conclusions


•   Growth in dialysis patients is considerable, but fairly
    predictable at a provincial level.

•   All incident patients (including acute renal failure)
    should be accounted for in the analysis. Inclusion of
    only chronic patients underestimates the true need for
    dialysis services and the required amount of resources.

•   It is feasible to develop a plan for service expansion
    that is long-term, transparent and consistent.




Evidence guiding health care

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:5/16/2013
language:English
pages:50
tang shuming tang shuming
About