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"The right care, to the right patient, at the right time."

 Dr. Sara Davison

Implementation and Evaluation of the Conservative Kidney Management Pathway Across Alberta

Conservative Kidney Management (CKM) is planned, comprehensive, person-centered care for patients with end stage chronic kidney disease (CKD) for whom dialysis is unlikely to provide benefit based on informed and shared decision-making. CKM integrates palliative care principles (such as advance care planning (ACP), symptom management, psychosocial and family support) with interventions to delay progression and minimize complications of CKD and excludes dialysis.

This project builds on current successes and innovations piloting the CKM pathway in Northern Alberta. The pilot work has engaged the community, developed the methodology, provided proof of concept and has developed consensus within the Alberta nephrology community for standards of CKM and clinical guidelines that will inform this project, and will move forward CKM internationally.

The aims of this project are to work with Primary Care Networks to enhance and spread the implementation of an innovative CKM Pathway to community care across Alberta to improve patient outcomes for CKD patients unlikely to benefit from dialysis while providing better value for money. This work will operationalize innovative care creating sustainable transformation, set a benchmark for national and international jurisdictions, and will serve as a model for pathway development and integrated care for other vulnerable people with complex chronic illness.

This project is funded by the Canadian Institute of Health Research.

Development, Implementation and Evaluation of a Conservative Kidney Management Pathway

In partnership with the Kidney Health Strategic Clinical NetworkTM, the Kidney Supportive Care Research Group (KSCRG) developed, piloted and and evaluated an interactive, web-based Conservative Kidney Management (CKM) pathway in four Northern Alberta Renal Program outpatient Chronic Kidney Disease clinics.

The CKM pathway has been developed for patients with end stage kidney failure unlikely to benefit from chronic dialysis and who choose conservative (non-dialysis) care. These patients may live as long as those who decide to start dialysis, while still maintaining a better quality of life.

The pathway coordinates kidney care with relevant primary and palliative care services, and will incorporate new initiatives currently being developed and rolled out under the direction of Alberta Health Services. It is anticipated that the CKM pathway will reduce the burden on acute care facilities as well as enable quality, efficient, cost-effective and standardized CKM care, regardless of location. The  CKM pathway will also enable greater control for patients and their families to make decisions regarding dialysis or CKM consistent with their values and goals. Comprehensive evaluation is ongoing.

This project was funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

Patient Engagement: Development, Implementation and Evaluation of a Patient Decision Aid

Older frail patients with other health problems often experience functional and cognitive decline after starting dialysis and therefore may choose conservative kidney management (CKM). Communicating treatment options around either dialysis or CKM to patients is challenging for both healthcare providers and patients/families.

Patient decision aids (PDAs) provide a structured, evidence-based platform for staff to engage patients in these difficult conversations. PDAs have also have been shown to improve patient’s knowledge regarding treatment options, reduce their decisional conflict related to feeling uninformed and unclear about their personal values, enables them to take a more active role in decision-making and improves congruence between the chosen option and their values. PDAs are particularly beneficial when each option has benefits and harms that patients may value differently.

Information from the CKM pathway aided in the development and implementation an interactive, web-based PDA around the appropriate initiation of dialysis versus CKM based on the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. Comprehensive evaluation is ongoing.

This project was funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

Dr. Sara Davison speaking with patient at dialysis unit

Northern Alberta Renal Program (NARP) Clinical Initiatives

Supportive Care Initiative: Identifying Patients at Risk

Advanced Care Planning (ACP) Initiative

Chronic Pain Assessment and Management Initiative

This initiative deals with the development and implementation of routine and systematic processes to identify all high risk stage 5 chronic kidney disease (CKD) patients most likely to benefit from supportive care interventions (Davison 2011).

This supportive care framework has sparked change across Canada. In addition, the framework and kidney supportive care strategies are being implemented across North America and Europe.

It incorporates sustainable kidney supportive care education for all NARP staff including competency-based ACP skill acquisition and symptom management.

The advanced care planning process is evolving from a document-driven decision focused event to one that emphasizes a patient-centred process focusing on conversations around broader goals of care.

This ongoing initiative involves the intensive skills training of multi-professional ACP facilitators. The project’s focus is on the development and implementation of processes to systematically facilitate ACP for patients most at need within NARP.

The ACP Initiative was designed to complement the provincial rollout of the Goals of Care Designation (GCD). A full QI strategy to evaluate the project has been implemented.

In collaboration with the ACP Collaborative Research and Innovation Opportunities Program (CRIO), we have led the development of new tools to measure patient engagement in the ACP process: the Behaviours in Advance Care Planning and ACtions Survey (BACPACS).

Pain is one of the most commonly experienced and debilitating symptoms of patients with advanced Chronic Kidney Disease (CKD) and is not typically improved by dialysis.

This ongoing project involved the development and implementation of tools and strategies for the routine and systematic assessment and management of chronic pain in patients with advanced CKD.

Comprehensive evaluation is ongoing.

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Vision: To help people enjoy life while living with advanced chronic kidney disease by becoming a world leader in kidney supportive care research and clinical innovation.

Kidney Supportive Care Research Group (KSCRG)  l  Mailing Address: 8-105 Clinical Sciences Building, University of Alberta, 11350 83 Avenue NW, Edmonton, AB, T6G 2G3  l  Email: kscrg@ualberta.ca  l  Phone: (780) 492-0926 l  Fax: (780) 407-8117

In partnership with the Kidney Health Strategic Clinical NetworkTM, the Kidney Supportive Care Research Group (KSCRG) developed, piloted and and evaluated an interactive, web-based Conservative Kidney Management (CKM) pathway in four Northern Alberta Renal Program outpatient Chronic Kidney Disease clinics.

Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit

Dr. Sara Davison speaking with patient at dialysis unit

Dr. Sara Davison speaking with patient at dialysis unit

Conservative Kidney Management (CKM) is planned, comprehensive, person-centered care for patients with end stage chronic kidney disease (CKD) for whom dialysis is unlikely to provide benefit based on informed and shared decision-making. CKM integrates palliative care principles (such as advance care planning (ACP), symptom management, psychosocial and family support) with interventions to delay progression and minimize complications of CKD and excludes dialysis.

This project builds on current successes and innovations piloting the CKM pathway in Northern Alberta. The pilot work has engaged the community, developed the methodology, provided proof of concept and has developed consensus within the Alberta nephrology community for standards of CKM and clinical guidelines that will inform this project, and will move forward CKM internationally.

The aims of this project are to work with Primary Care Networks to enhance and spread the implementation of an innovative CKM Pathway to community care across Alberta to improve patient outcomes for CKD patients unlikely to benefit from dialysis while providing better value for money. This work will operationalize innovative care creating sustainable transformation, set a benchmark for national and international jurisdictions, and will serve as a model for pathway development and integrated care for other vulnerable people with complex chronic illness.

This project is funded by the Canadian Institute of Health Research.

In partnership with the Kidney Health Strategic Clinical NetworkTM, the Kidney Supportive Care Research Group (KSCRG) developed, piloted and and evaluated an interactive, web-based Conservative Kidney Management (CKM) pathway in four Northern Alberta Renal Program outpatient Chronic Kidney Disease clinics.

The CKM pathway has been developed for patients with end stage kidney failure unlikely to benefit from chronic dialysis and who choose conservative (non-dialysis) care. These patients may live as long as those who decide to start dialysis, while still maintaining a better quality of life.

The pathway coordinates kidney care with relevant primary and palliative care services, and will incorporate new initiatives currently being developed and rolled out under the direction of Alberta Health Services. It is anticipated that the CKM pathway will reduce the burden on acute care facilities as well as enable quality, efficient, cost-effective and standardized CKM care, regardless of location. The  CKM pathway will also enable greater control for patients and their families to make decisions regarding dialysis or CKM consistent with their values and goals. Comprehensive evaluation is ongoing.

This project was funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

Older frail patients with other health problems often experience functional and cognitive decline after starting dialysis and therefore may choose conservative kidney management (CKM). Communicating treatment options around either dialysis or CKM to patients is challenging for both healthcare providers and patients/families.

Patient decision aids (PDAs) provide a structured, evidence-based platform for staff to engage patients in these difficult conversations. PDAs have also have been shown to improve patient’s knowledge regarding treatment options, reduce their decisional conflict related to feeling uninformed and unclear about their personal values, enables them to take a more active role in decision-making and improves congruence between the chosen option and their values. PDAs are particularly beneficial when each option has benefits and harms that patients may value differently.

Information from the CKM pathway aided in the development and implementation an interactive, web-based PDA around the appropriate initiation of dialysis versus CKM based on the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. Comprehensive evaluation is ongoing.

This project was funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

Dr. Sara Davison speaking with patient at dialysis unit

This project builds on current successes and innovations piloting the CKM pathway in Northern Alberta. The pilot work has engaged the community, developed the methodology, provided proof of concept and has developed consensus within the Alberta nephrology community for standards of CKM and clinical guidelines that will inform this project, and will move forward CKM internationally.

The aims of this project are to work with Primary Care Networks to enhance and spread the implementation of an innovative CKM Pathway to community care across Alberta to improve patient outcomes for CKD patients unlikely to benefit from dialysis while providing better value for money. This work will operationalize innovative care creating sustainable transformation, set a benchmark for national and international jurisdictions, and will serve as a model for pathway development and integrated care for other vulnerable people with complex chronic illness.

This project is funded by the Canadian Institute of Health Research.

The CKM pathway has been developed for patients with end stage kidney failure unlikely to benefit from chronic dialysis and who choose conservative (non-dialysis) care. These patients may live as long as those who decide to start dialysis, while still maintaining a better quality of life.

The pathway coordinates kidney care with relevant primary and palliative care services, and will incorporate new initiatives currently being developed and rolled out under the direction of Alberta Health Services. It is anticipated that the CKM pathway will reduce the burden on acute care facilities as well as enable quality, efficient, cost-effective and standardized CKM care, regardless of location. The  CKM pathway will also enable greater control for patients and their families to make decisions regarding dialysis or CKM consistent with their values and goals. Comprehensive evaluation is ongoing.

This project was funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

Patient decision aids (PDAs) provide a structured, evidence-based platform for staff to engage patients in these difficult conversations. PDAs have also have been shown to improve patient’s knowledge regarding treatment options, reduce their decisional conflict related to feeling uninformed and unclear about their personal values, enables them to take a more active role in decision-making and improves congruence between the chosen option and their values. PDAs are particularly beneficial when each option has benefits and harms that patients may value differently.

Information from the CKM pathway aided in the development and implementation an interactive, web-based PDA around the appropriate initiation of dialysis versus CKM based on the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. Comprehensive evaluation is ongoing.

Dr. Sara Davison speaking with patient at dialysis unit

This project was funded by Alberta Innovates – Partnership for Research and Innovation in the Health System (PRIHS)

The right care, to the right patient, at the right time.

 Dr. Sara Davison

This project is funded by the Canadian Institute of Health Research.

The CKM pathway has been developed for patients with end stage kidney failure unlikely to benefit from chronic dialysis and who choose conservative (non-dialysis) care. These patients may live as long as those who decide to start dialysis, while still maintaining a better quality of life.

The pathway coordinates kidney care with relevant primary and palliative care services, and will incorporate new initiatives currently being developed and rolled out under the direction of Alberta Health Services. It is anticipated that the CKM pathway will reduce the burden on acute care facilities as well as enable quality, efficient, cost-effective and standardized CKM care, regardless of location. The  CKM pathway will also enable greater control for patients and their families to make decisions regarding dialysis or CKM consistent with their values and goals. Comprehensive evaluation is ongoing.

Patient decision aids (PDAs) provide a structured, evidence-based platform for staff to engage patients in these difficult conversations. PDAs have also have been shown to improve patient’s knowledge regarding treatment options, reduce their decisional conflict related to feeling uninformed and unclear about their personal values, enables them to take a more active role in decision-making and improves congruence between the chosen option and their values. PDAs are particularly beneficial when each option has benefits and harms that patients may value differently.

Dr. Sara Davison speaking with patient at dialysis unit

Information from the CKM pathway aided in the development and implementation an interactive, web-based PDA around the appropriate initiation of dialysis versus CKM based on the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. Comprehensive evaluation is ongoing.

The aims of this project are to work with Primary Care Networks to enhance and spread the implementation of an innovative CKM Pathway to community care across Alberta to improve patient outcomes for CKD patients unlikely to benefit from dialysis while providing better value for money. This work will operationalize innovative care creating sustainable transformation, set a benchmark for national and international jurisdictions, and will serve as a model for pathway development and integrated care for other vulnerable people with complex chronic illness.

This project is funded by the Canadian Institute of Health Research.

Dr. Sara Davison speaking with patient at dialysis unit
Dr. Sara Davison speaking with patient at dialysis unit