Patient Engaged Clinical Pathways: An Update from BCCH

Cherry Mammen, MD, FRCPC, MHSc Clinical Assistant Professor (UBC) Division of Nephrology, BC Children’s Hospital BC Kidney Days Oct 6th, 2016

Childhood Nephrotic Syndrome (NS) Clinical Pathway

Introduced at BC Kidney Days 2015 (Dr. Janis Dionne)

Reasons for a NS clinical pathway

Common pediatric nephrology condition 12-15 incident pts/yr (BC) >100 prevalent patients (BC)

Geographical considerations Pediatricians often responsible for care

Significant local practice variation prednisone dosing, investigations, follow-up,

charting

NS Clinical Pathway Resources

• Types of nephrotic syndrome • Complications of nephrotic syndrome • Prednisone course & side effects • How to dip urine for protein • Dietary recommendations • Immunizations and infections • Ongoing care

Patient Home Monitoring

Surveillance Checklist

BC Pediatrician Survey (2015)

NS Parent/Patient Survey

New Evidence Informs Pathway Change

New Evidence Informs Pathway Change

Teeninga N, JASN 2013 Sinha A, Kidney Int 2014 Yoshikawa N, Kidney Int 2014

‘Old’ Dosing Regimen

‘New’ Dosing Regimen (Apr 16)

Cumulative Dose: Old: 4095 mg/m2 New: 3360 mg/m2

A Clinical Pathway is a Quality Improvement Tool

36 patients have entered the pathway Detailed audit of pathway underway

Our Clinical Pathway Team

E-mail: cmammen@cw.bc.ca