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
