How renal care in Ontario is transforming
When the Ontario Renal Network launched in 2009, delivery of kidney care services in the province had hardly changed in a decade.
Costs were rising in this very expensive area of healthcare, yet quality measures and innovation were lacking. Best practices in treatments and types of care were not promoted or properly supported. Funding was inconsistent across centres and provided through an outdated formula.
Most importantly, patients had little input to how their services were delivered.
The Ontario Renal Network was set up to correct this. The aim was to improve the quality of care by making it more person-centred, evidence-based, transparent, accountable and equitable.
Policies were established after extensive stakeholder consultation, laid out in Ontario Renal Plans and implemented in a sustainable manner through the “network” that is the organization's essence.
We're proud to see considerable progress towards our goals.
What is different now?
Most significantly, the ethos of renal care in Ontario has changed in two crucial respects. First, delivery of renal care is now person-centred in a very meaningful way.
Our Patient and Family Advisory Council (PFAC) is consulted on every province-wide decision, and having its endorsement on provincial initiatives is non-negotiable. At the local level, almost all of the 27 Renal Programs now have their own PFACs, who review local decisions and provide feedback.
At an individual patient level, the tenets of person-centred care are widely advocated and concepts such as Shared Decision Making are discussed, expected and increasingly practised widely.
In the second major change, co-management of the renal care system is also now a reality of how the Ontario Renal Network operates.
Physician co-management is reflected by the involvement of 14 regional and nine provincial medical leads. Regional directors, physicians, nurse leaders and other allied health professionals act through the Ontario Renal Network Executive, the Provincial Leadership Forum and Provincial Leadership Table and a variety of priority panels and associated work groups to influence, decide and implement policy and priorities.
Because of all this stakeholder involvement, agreed policies now have widespread endorsement. They are "network" policies and the "network" aspect to the organization is real.
The province-wide Ontario Renal Reporting System (ORRS) has also been put in place to ensure standardized data reporting, which is then used to ensure transparency and to compare outcomes and promote quality care for all patients.
To support all of this, a whole new funding formula has been established for renal care. Reimbursement for services is now standardized, transparent and fair across the province.
Transforming patient care
These big-picture changes have resulted in more tangible improvements for patients.
For example, more frequent hemodialysis regimens, in which Ontario has been a world leader, are now specifically recognized and funded.
Home dialysis has been well funded and encouraged, bringing the prevalent rate up to 26 per cent. Home dialysis options give patients more flexibility in choosing where and how they receive care, while saving the overall system millions of dollars. The financial burden for patients has been lessened by the introduction of a Home Hemodialysis Utility Grant to pay for extra water and hydro costs incurred.
The optimal treatment for end-stage kidney disease from both a patient and a system perspective is transplantation. To meet this objective, we – in collaboration with the Trillium Gift of Life Network – have a major initiative underway to increase living donor transplant rates, which have been stagnant for almost two decades.
More initiatives under way
There are many other initiatives under way as we aim to improve quality, reduce inequities and increase access to the system.
Some are in their early stages, while others are well advanced. However, all have benefited greatly from the enthusiasm of the network of Renal Programs and of stakeholders, including patients and their relatives. The support has been gratifying.
A few examples should be mentioned. We are working to improve delivery of care to remote communities and to address the distressingly high rates of renal disease in patients from First Nations, Inuit, Métis and urban Indigenous groups. Meanwhile, a province-wide network of specialty clinics has been launched to treat the critically important areas of glomerulonephritis and renal disease in pregnancy.
An initiative to improve the quality of primary care referrals and to improve safe medication prescribing in patients with kidney failure is under way. Other initiatives focus on making palliative care available to renal patients who need it; addressing patient reported outcomes and on treating the associated patient symptom burden; and avoiding unnecessarily early starts on chronic dialysis.
All this represents a major change in Ontario in how renal care is being delivered. The future is bright. The simultaneous potential of improved patient care and reduced costs for the healthcare system are a ‘win win’ for everyone involved.
This blog is one in a continuing series marking CCO's 75 years of transformation in Ontario healthcare.
Dr. Peter Blake is the Ontario Renal Network's provincial medical director and a nephrologist working in London, Ontario. He is a professor of Medicine and former chair of the Division of Nephrology at Western University and London Health Sciences Centre.