Implementing learning health systems in the nephrology program to enhance value-based healthcare delivery

Abstract

The Health Accord for Newfoundland and Labrador recommended the creation of learning health system (LHS) to improve healthcare delivery in our province. The Nephrology Program identified two opportunities to collect data to implement improved care consistent with a local LHS: (1) decreased time on in-centre hemodialysis (ICHD) and (2) increased uptake of home dialysis. First, a direct method for calculating urea distribution volume in ICHD patients was compared to the current method of monitoring dialysis dose. The two volumes were used to calculate independent dialysis doses, Kt/V. The mean Kt/V difference was significantly higher for the direct method, a difference that was greater in obese patients and amputees. This suggests current methods overestimate volume, underestimate Kt/V, and lead to prescriptions for increased dialysis time. Second, metrics of newly started dialysis patients were analyzed for differences between ICHD and home dialysis patients and their care, to identify barriers to transitioning to home modalities. Five barriers were identified, including less pre-dialysis staff exposure and lower rates of discussions of home dialysis options. These data can be used to implement Nephrology Program LHS cycles in ongoing quality improvement initiatives, with multifaceted outcome goals in healthcare delivery, including patient care experience, population health, and health care delivery cost.