BC Kidney Days - Provincial Update October 6, 2016

Dr. Adeera Levin, Executive Director BC Renal Agency

Welcome to BC Kidney Days 2016

Overview

• Kidney Disease in BC

• BC’s Model is Unique Nationally and Internationally – Structure and function – Network of multidisciplinary committees – Highlights and accomplishments – Strategic priorities

• Congratulations and New Faces

Ten Year Overview

Ten Year Overview

BC Renal vision and mission

Vision – An innovative, integrated health system

resulting in outstanding care for patients living with kidney disease.

Mission – Integrating knowledge and practice for

better kidney health

Form follows function

• Patients at centre of org chart

• Health authorities responsible for program delivery

• BCPRA overarching support for those programs, and accountable to PHSA & MOH for outcomes

Provincial Committee Structure

• Multidisciplinary committees

• Cross-HA representation

• Annual work plans with clear deliverables

• Research, evaluation and CQI

Provincial Initiatives: 2013 2015/16 Provincial Committee Highlights: Kidney Care Committee • Modality choices patient training materials

• Adult and pediatric; translated; “watch at home”; booklet form

• Conservative care pathway (with Palliative Committee)

• Symptom assessment and management

• KCC med rec in PROMIS

• Monthly online education seminars

Live poll ? – What percentage of KCC patients with GFR <20 opts for conservative care over dialysis or transplant?

a) 5% b) 10% c) 15% d) 25%

Provincial Initiatives: 2013 2015/16 Provincial Committee Highlights Palliative Care Committee • Development of renal palliative quality data indicators report

• Supporting programs in symptom burden ID (dialysis/late CKD) using “My Symptom Checklist”

• Supporting programs in use of ACP Module (PROMIS)

• PCC research group: completion of two studies: use of prognostication model to predict mortality in HD pts

• Manuscript/abstract development

• ACP video guide

Provincial Initiatives: 2013 2015/16 Provincial Committee Highlights Home Hemodialysis Committee

• Provincial rollout of NxStage machine

• Development of NxStage materials to support HHD programs

• Development of provincial tools/ protocols to support HHD patients & programs address barriers to independence:

• Patient agreement, resources for rural/remote health care facilities, information re: septic systems and HHD

• Provincial contract management • Home Therapies research group

Live poll ? – When was the provincial home hemodialysis program launched?

a) 2000 b) 2004 c) 2010 d) 1986

Provincial Initiatives: 2013 2015/16 Provincial Committee Highlights PD Committee • PD Assist – approved for prov rollout

• Submission of manuscripts for publication

• Online e-learning modules

• PD exit reasons PROMIS module

• Western Canada PD Days

• BCIT Collaboration: online advanced PD course

• Provincial contract management • Home Therapies research group

2015/16 Provincial Committee Highlights Hemodialysis Committee

• Nocturnal HD program implementation guide

• HD patient welcome package

• Visiting/traveling patients guideline/materials

• Missed appointment guideline

• Readiness to leave HD unit guideline

• Development of quality data indicators

Provincial Initiatives: 2013 2015/16 Provincial Committee Highlights Glomerulonephritis (GN Committee)

• Formulary management/adjudication

• Registry data collection & data quality

• Clinical protocols and supporting evidence: – Major drug interactions with cyclosporine

and tacrolimus – Membranous nephropathy protocols

(calcineurin inhibitor & cyclophosphamide)

Live poll ? – How many cases of GN are diagnosed in BC each year?

a) 50 b) 125 c) 300 d) 450

2015/16 Committee Highlights Pharmacy Formulary Committee

• Formulary & contract management

• Patient/provider resources and tools

• Evaluation - novel disease modifying therapies

• Review of nutritional supplements with dietitians

• Participation in Can-SOLVE CKD study on deprescribing

2015/16 Committee Highlights Emergency Management Committee • Maintenance and implementation of provincial renal emergency response plans

• Ongoing promotion and education • Emergency preparedness month - May

2015/16 Other Highlights

Polycystic Kidney Disease • Province-wide registry (first in Canada) • Development of patient/provider resources re: Tolvaptan TB Screening program - new dialysis patients (First in Canada)

2015/16 Other Highlights • CKD e-learning sessions for Primary Care • World Kidney Day/Kidney Smart campaign

• Social media • Advertising: Van Sun/Province, public transit, ethnic media • WKD promotion

Live poll ? – How many people visited our kidneysmart.com webpage during Kidney Month this past March?

a) 5,000 b) 10,000 c) 15,000 d) 20,000

Strategic Priorities Moving Forward

Theme #1 Infrastructure Technology, Facilities, Finance

• PROMIS – Multi-year application road map; e-strategies

• Proactive facilities and equipment planning • Fiscal responsibility: funding model review, contract

management

Strategic Priorities Moving Forward

Theme #2 Outstanding Clinical Care

• Patient-centred philosophy • PREMs and PROMs

• Focus on transitions in care • Independent therapies, advance care planning,

collaboration with transplant • Strategic framework to address expensive new

medications • Telehealth: Indigenous and rural communities

Strategic Priorities Moving Forward

Theme #3 Enhancing the Mandate

• GN Network

• PKD initiative

• Exploring synergies across disease groups

Strategic Priorities Moving Forward

Theme #4 Research, Knowledge Translation, Education

• Leverage research and knowledge transfer to lead and foster change • Ongoing educational opportunities for care teams • CKD education for primary care

Why the network works

Matrix governance Patient focused

Protected renal funding - $170.8 million/year

Dedicated information system - PROMIS

Provincial contracts

Research/CQI

Together, we have demonstrated we can: • delay progression of CKD

• optimize outcomes of those on dialysis

• foster independent dialysis modalities

• increase pre-emptive transplantation

• ensure patients have access to the medications they require

Regional Innovations • Multiple quality

improvement initiatives across HA programs: – Funded through ‘value add’

dollars (see BCKD app)

– Posters at BCKD – www.bcrenalagency.ca >

For Health Professionals > Research

Sustainability and renewal: People PRA and UBC supported Advanced Training Fellowships 2015-16 • Clinical Fellowships - support of UBC training program

• Kathy Mac (Home Therapies) • Orla Dunne (Home Therapies to July 2016) • Jane Waugh (Advanced Nephrology Trainee) • Orla O’Brien (Advanced Nephrology Trainee) • Judy Graham (Advanced Nephrology Trainee)

• Administrative Fellowships

• Mike Bevilacqua (July 2015 – July 2017) • Elizabeth Lee (focus on Hemodialysis; July 2016)

Adult Nephrology

Core Training Neph Fellows - Morgan Lam (Y2) - Claire Harris (Y2) - Peter Birks ( Y1) - Arenn Jauhal (Y1) - Kris Poinen (Y1) Clinical Fellows Renal Transplant - Simardeep Gill - Basil Al Nasrallah - Teerayuth (Nick) Jiamjariyaporn

Welcome Pediatric Nephrology - Christine Mincham - Sawsan Al Batati - Isaac Elias - Lee Jin (Jean) Koh (starting Oct 1)

New Nephrologists - James Lan (VGH; Transplant

Immunology) - Yangmin Zeng (FH)

CNeph(C) Program Participants: Good Luck on the Exam!

Fraser Health - Grace Wong - Amritpal Guru - Evangeline Tamayo - Femarie Binuhe - Lorraine Geng - Bo (Michelle) Suk - Gurjit Cheema - Sharon Young - Youngsook Ha - Nena Cabauatan-

Terrace - Winnie Zimbiti - Jun Valentin - Vida Ighani - Lilia Fausto - Mohinder Sidhu - Kristina Hildebrandt

Interior Health - Julia Schaefer -Tiffani Smith - Breanne Crowell Northern Health - Jacqui Abernethy - Pressy Joy - Fern Johnson - Kendra Pilcik

Vancouver Coastal/ Providence - Ana Gatmaitan - Rajwinder Bhatti - Charlene Zhang - Christopher Perez - Susan Odle - Shazia Gillani - Aimee Paguirigan - JinMay Liu - Jeffrey Gilana - Lisa Holowaty - Christine Zamora - Megan Lee - Catherine Uy

Vancouver Island Health - Kate Wilson - Arlene Kibble - Rachel Blakely - Paula Cox - Adam Nelles-Boulton - Whitney Nelson - Maren McLean - Anita Rand - Calais Gionet - Diane Jones - Natalie Carver - Esme Cull - Carmen Simpson - Melinda O'Neill - Kaitlyn Hopkins - Shelley Mcleod-Garner - Lana Howe

Thank you to all renal care teams!

Thank you to those you do not see

• PROMIS team • Statisticians and

Methodologists • BCPRA Administrative Staff

The BC Renal Network: What We Do • Focus on patient outcomes

• Focus on knowledge translation – What we know what we do – What works in the real world

• Focus on creating systems that optimize outcomes

Thank you for your energy & commitment to people living with kidney disease

• Over 300 people actively involved in our network: • BCPRA committees • Professional groups

• All health care team members directly contribute to patient wellness

• The BCPRA is us, working together

Your feedback is important!

Use the BCKD app

Enjoy the conference!