Better Care for CKD Service

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Rachael Walker
Clinical Nurse Specialist
Renal Department
Hawkes Bay District Health Board

Stuart Barson
HSA Global
(Thursday, 3.35pm, Clinicians' Challenge)

Published in: Health & Medicine
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Better Care for CKD Service

  1. 1. Better Care for CKD Service HSAGlobal & Hawke’s Bay DHB
  2. 2. The Background Approx 17,000 people in HB have Chronic Kidney Disease (CKD) Early detection and management is better and more cost effective The majority of CKD patients can be managed in primary care Secondary care needs to see the complex patients and support primary care
  3. 3. The Challenge Knowledge of patients  DHB audit shows it knows only 1/3 of patients with mod/severe kidney disease Risk stratifying patients Managing resources Creating timely systems and processes Improving integration and collaboration
  4. 4. Goals - service Knowledge of patient population Risk stratification of patients Improved care co-ordination More efficient use of specialist services Clear pathways Efficient communication Better support for primary care Improved patient outcomes
  5. 5. Goals - solution Take a shared care approach – NHITB plan Re-use existing CCMS solution for feasibility Include the new stratification model Share key information and enable actions  referral management  active involvement in care planning  patient interaction  close the loop with pharmacy
  6. 6. Integrated CKD solution
  7. 7. The Outcome Integration More effective communication Exemplar for other DHB’s renal services More efficient utilisation of resources $ better spent Better service planning Improved patient outcomes

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