More about the Chronic Kidney Disease HIT

Background

The Chronic Kidney Disease Health Integration Team (CKD HIT) is a team of clinical staff and patients, working together to improve patient outcomes and care pathways for patients with kidney disease.

6-7% of the population has kidney function of less than 60%, rising to over 30% in over 75s

The Health Survey for England found that 6-7 per cent of the population has kidney function of less than 60 per cent. This rises to over 30 per cent of the population over 75. The percentage with advanced disease is much lower.

In 2010, 1,250 individuals in the Bristol region had levels of kidney function low enough to necessitate renal replacement therapy, including haemodialysis (37 per cent), peritoneal dialysis (5 per cent) or kidney transplantation (58 per cent). CKD accounts for up to 2 per cent of NHS spending and is forecast to grow as the population ages and becomes more overweight. A third of dialysis patients experience heightened depression and psychological distress, with quality of life that is markedly lower than that experienced by patients with other chronic diseases and cancer.

With the introduction of routine reporting of kidney function in 2006, CKD awareness has increased dramatically. NICE has produced guidelines on CKD management in primary care and referral to secondary care services and these have been credited with better prevention in primary care and more timely referral to secondary care. As kidney function declines, the optimum level of kidney function at which to start dialysis or receive a transplant is still unclear. For some elderly patients dialysis may not prolong life by many months and some patients, although they want to live as long as possible, are not willing to do so at any cost. Nor is kidney transplantation right for everyone, but it is important that access to the waiting list does not depend on socio-economic status, ethnic group or where you live. Patients must be provided with the facts they need, at the appropriate time, in an understandable format, to make the decision that is right for them.

The Richard Bright Renal Unit at Southmead Hospital provides CKD, dialysis and acute kidney injury (AKI) services for a population of approximately 1.5 million and kidney transplantation services for approximately 2.5 million. In practice this means patients travelling from as far afield as Bridgewater, Warminster and Chippenham for dialysis education and dietary advice, while patients within the first few weeks of kidney transplantation can be travelling to Southmead three times a week from Bournemouth, Dorchester and Gloucester. Not only is this environmentally unsustainable, but it is recognised that proximity to specialist care increases the likelihood of receiving such care.

Aims and objectives

The CKD HIT aims to improve outcomes for patients with kidney disease in the Bristol area through:

  • Prevention: reducing rates of AKI and reducing inequalities in management of CKD in primary and secondary care.
  • Patient care: introducing routine patient reported outcome measure reporting and shared decision making; exploring ways to provide care nearer patients' homes; reducing inequities in access to treatment; developing evidence based interventions to improve the care of young adults with CKD.
  • Education: disseminating best practice through a programme of CKD education and support for doctors and nurses in the community and hospitals without renal services.
  • Research: developing the infrastructure for applied renal research in Bristol to support a portfolio including observational studies, secondary databases (the UK Renal Registry at Southmead) and clinical trials and attract the next generation of clinical and non-clinical researchers into renal research. In some cases the observational evidence on variations in care by renal centre will provide the impetus for cluster randomised trials to test whether the implementation of new service delivery will itself alter patient outcomes.

Who's involved

The leading experts in kidney disease in Bristol are involved in the team. The HIT's directors are Dr Fergus Caskey, Consultant Nephrologist at North Bristol NHS Trust and Medical Director of the UK Renal Registry, and Dr Udaya Udayaraj, Consultant Nephrologist at North Bristol NHS Trust. The team includes doctors, nurses, a patient and carer.

Find out more about who's involved in the Chronic Kidney Disease HIT.

How patients and the public are involved

At the moment the team includes Angela and William Beale, who give a patient's and carer's perspective both during meetings and across projects. William is a live donor for his wife Angela. Further patient and public involvement is being sought to capture a range of views across the patient demographic and Bristol area.

Other ways patients and the public are involved include:

  • Involvement in service design, for example new clinics
  • Using patient satisfaction data to evaluate changes

Projects and activities

Key projects for the team include:

  • A pilot study of patient reported outcome measure (PROM) data collection and reporting in dialysis patients.
  • Tele-care and remote monitoring, including:
    • Telephone clinics to promote sustainability and improve patient satisfaction.
    • Providing information and advice to GPs, including the development and testing of new algorithms of care, some of which may be automated.
    • Developing an integrated IT system that will allow clinicians, both in primary and secondary care, access to patient databases to enable remote monitoring and advice.
  • Acute kidney injury (AKI): the team is involved in a national pathfinder project led by NHS England to reduce the incidence and to improve management of AKI. The project will review the interfaces between the different stages of the AKI pathway to identify opportunities for better risk assessment, early detection and appropriate intervention in primary and secondary care.

Contacts

To find out more, please contact:


View the 2015 video here

More about the Chronic Kidney Disease HIT

Background

The Chronic Kidney Disease Health Integration Team (CKD HIT) is a team of clinical staff and patients, working together to improve patient outcomes and care pathways for patients with kidney disease.

6-7% of the population has kidney function of less than 60%, rising to over 30% in over 75s

The Health Survey for England found that 6-7 per cent of the population has kidney function of less than 60 per cent. This rises to over 30 per cent of the population over 75. The percentage with advanced disease is much lower.

In 2010, 1,250 individuals in the Bristol region had levels of kidney function low enough to necessitate renal replacement therapy, including haemodialysis (37 per cent), peritoneal dialysis (5 per cent) or kidney transplantation (58 per cent). CKD accounts for up to 2 per cent of NHS spending and is forecast to grow as the population ages and becomes more overweight. A third of dialysis patients experience heightened depression and psychological distress, with quality of life that is markedly lower than that experienced by patients with other chronic diseases and cancer.

With the introduction of routine reporting of kidney function in 2006, CKD awareness has increased dramatically. NICE has produced guidelines on CKD management in primary care and referral to secondary care services and these have been credited with better prevention in primary care and more timely referral to secondary care. As kidney function declines, the optimum level of kidney function at which to start dialysis or receive a transplant is still unclear. For some elderly patients dialysis may not prolong life by many months and some patients, although they want to live as long as possible, are not willing to do so at any cost. Nor is kidney transplantation right for everyone, but it is important that access to the waiting list does not depend on socio-economic status, ethnic group or where you live. Patients must be provided with the facts they need, at the appropriate time, in an understandable format, to make the decision that is right for them.

The Richard Bright Renal Unit at Southmead Hospital provides CKD, dialysis and acute kidney injury (AKI) services for a population of approximately 1.5 million and kidney transplantation services for approximately 2.5 million. In practice this means patients travelling from as far afield as Bridgewater, Warminster and Chippenham for dialysis education and dietary advice, while patients within the first few weeks of kidney transplantation can be travelling to Southmead three times a week from Bournemouth, Dorchester and Gloucester. Not only is this environmentally unsustainable, but it is recognised that proximity to specialist care increases the likelihood of receiving such care.

Aims and objectives

The CKD HIT aims to improve outcomes for patients with kidney disease in the Bristol area through:

  • Prevention: reducing rates of AKI and reducing inequalities in management of CKD in primary and secondary care.
  • Patient care: introducing routine patient reported outcome measure reporting and shared decision making; exploring ways to provide care nearer patients' homes; reducing inequities in access to treatment; developing evidence based interventions to improve the care of young adults with CKD.
  • Education: disseminating best practice through a programme of CKD education and support for doctors and nurses in the community and hospitals without renal services.
  • Research: developing the infrastructure for applied renal research in Bristol to support a portfolio including observational studies, secondary databases (the UK Renal Registry at Southmead) and clinical trials and attract the next generation of clinical and non-clinical researchers into renal research. In some cases the observational evidence on variations in care by renal centre will provide the impetus for cluster randomised trials to test whether the implementation of new service delivery will itself alter patient outcomes.

Who's involved

The leading experts in kidney disease in Bristol are involved in the team. The HIT's directors are Dr Fergus Caskey, Consultant Nephrologist at North Bristol NHS Trust and Medical Director of the UK Renal Registry, and Dr Udaya Udayaraj, Consultant Nephrologist at North Bristol NHS Trust. The team includes doctors, nurses, a patient and carer.

Find out more about who's involved in the Chronic Kidney Disease HIT.

How patients and the public are involved

At the moment the team includes Angela and William Beale, who give a patient's and carer's perspective both during meetings and across projects. William is a live donor for his wife Angela. Further patient and public involvement is being sought to capture a range of views across the patient demographic and Bristol area.

Other ways patients and the public are involved include:

  • Involvement in service design, for example new clinics
  • Using patient satisfaction data to evaluate changes

Projects and activities

Key projects for the team include:

  • A pilot study of patient reported outcome measure (PROM) data collection and reporting in dialysis patients.
  • Tele-care and remote monitoring, including:
    • Telephone clinics to promote sustainability and improve patient satisfaction.
    • Providing information and advice to GPs, including the development and testing of new algorithms of care, some of which may be automated.
    • Developing an integrated IT system that will allow clinicians, both in primary and secondary care, access to patient databases to enable remote monitoring and advice.
  • Acute kidney injury (AKI): the team is involved in a national pathfinder project led by NHS England to reduce the incidence and to improve management of AKI. The project will review the interfaces between the different stages of the AKI pathway to identify opportunities for better risk assessment, early detection and appropriate intervention in primary and secondary care.

Contacts

To find out more, please contact:


View the 2015 video here
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