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Methodology - System Performance Data

Here we describe the methodologies used for reporting System Performance data for chronic kidney disease care in Ontario. We report on 3 indicators based on the goals in the Ontario Renal Plan 2015 to 2019.

 Proportion of vascular access surgery for dialysis cases completed within target wait time, reported by priority
Data Source Wait Time Information System
Rationale for Reporting This indicator supports the measurement of strategic objectives: "identify barriers to accessing kidney care and develop person-centred solutions", and "ensure infrastructure and services are in place to enable home dialysis". Also, the Renal Programs must meet certain expectations outlined in the Funding Agreement, including improvement in number of surgical cases falling within the Wait time 2 target timeframe.
Denominator

Case cohort (cumulative of past 4 quarters of data):

  • Cases with the following service detail codes:
  1. VASC ASDL AVFIST Arteriovenous Fistula
  2. VASC ASDL AVGRFT Arteriovenous Graft
  3. VASC ASDL OASDL Other Arteriovenous Surgery
  • Closed (or completed) wait list entries with actual procedure dates within date range
  • Patients that are 18 years and older on the day the procedure was completed
  • Procedures assigned as priority levels 2 or 3

Exclusions:

  • Procedures no longer required (all reasons)
  • Procedures assigned as priority level 1
  • Wait list entries identified by hospitals as data entry errors 
Numerator

Subset of denominator:

  • Cases completed within the Wait 2 target timeframe (i.e. 14 and 28 days for priority 2 and 3 cases respectively)
Considerations

Restrictions: Wait 2 is measured from the Decision To Treat (DTT) date to the date the procedure is performed. Dates Affecting Readiness to Treat (DART) are deducted from wait 2 days

Surgical procedures performed outside of a fully equipped operating room are not considered. Fully equipped operating rooms include: - 71260** - in-patient operating room - 71262 - in-patient operating room / post anaesthetic recovery room (PARR) - 71367 - day surgery pre and post-operative care - 71360 - day surgery operating room - 71362 - day surgery combined OR and PARR - 71365 - day surgery post-anaesthetic recovery room - 71369 - day surgery combined OR, PARR and pre and post care.

The reported rates, denominators and numerators are calculated using the last four quarters.

Proportion of prevalent chronic dialysis patients on a home dialysis modality
Data Source Ontario Renal Reporting System
Rationale for Reporting Home modalities have been shown to enable the best clinical outcomes, quality of life, and independence for dialysis patients. This indicator speaks to the Ontario Renal Network’s ability to make the modalities associated with best outcomes accessible to Ontarians. Also, the Renal Programs must meet certain expectations outlined in the Funding Agreement, which include improved prevalent home dialysis rates.
Denominator

Patient Cohort:

  • Patients who are receiving chronic dialysis at the time of reporting
  • Patients who are receiving home dialysis training (Home HD or PD) at the time of reporting

Exclusions:

  • Patients younger than 18 years old
Numerator Subset of Denominator:
  • Patients who are receiving chronic dialysis on a home dialysis modality ( Home or PD)
Considerations None
Proportion of incident chronic dialysis patients with deferred elective dialysis start
Data Source Ontario Renal Reporting System
Rationale for Reporting

This indicator aims to prevent early dialysis initiation given the lack of benefit and increased resource utilization. This means access to the right services, at the right time.
This indicator supports the measurement of a strategic objective: “Establish a community-first approach to kidney care".

Denominator

Patient Cohort:

  • Patients who initiated chronic dialysis

Exclusions:

  • Patients younger than 18 years old
  • Patients who recovered kidney function within 30 days after dialysis initiation
  • Patients with less than 90 days from first seen by nephrologist to dialysis initiation
Numerator Subset of Denominator:
  • Patients whose eGFR (CKD-EPI) at the initiation of chronic dialysis was at or below 9.5ml/min
Considerations None