Referral to a Multi-Care Kidney Clinic – Indicator Methodology

• Two eGFR values less than 15ml/min/1.73m2 that are separated by 90 days but no more than 365 days apart (outpatient lab results only), OR
• Two 2-year KFRE of at least 10% that are separated by 90 days but no more than 365 days apart (outpatient lab results only). For a KFRE, the urine ACR must be between 30 days before and 7 days after the corresponding serum creatinine. KFRE date is based on the latest urine ACR or serum creatinine date used to calculate KFRE.

AND

Have been followed by a nephrologist (i.e., 1 outpatient nephrologist visit in the year prior to the index date, and 1 outpatient nephrologist visit in the year after).

Outpatient nephrologist visit is identified based on one of 3 ways:

• Internal medicine visit (fee codes: “A130,” “A131,” “A133,” “A134,” “A135,” “A136,” “A138,” “A435” in OHIP Claims Database), and confirming that the billing physician (i.e., CPSO in CPDB) is a nephrologist (i.e., based on ORN nephrologist data), OR
• Nephrology visit (fee codes: “A160,” “A161,” “A163,” “A164,” “A165,” “A166,” “A168” in OHIP Claims Database), OR
• Specialist consultation or visit by telephone or video (fee code: “K083” in OHIP Claims Database), and confirming that the billing physician (i.e., CPSO in CPDB) is a nephrologist (i.e., based on ORN nephrologist data)

In all above cases, we exclude visits billed while the patient is hospitalized or on the day of an ER visit.

Note: The index date is based on the first urine ACR or creatinine date that can be used to calculate the second eligible KFRE or eGFR value.

Exclusions:

• Those who are younger than 18 years old as of the index date
• Those who received chronic dialysis or a kidney transplant on or prior to the index date
• Those who died within a year after the index date
• Those who do not have OHIP coverage (i.e., patient's health card number in OLIS does not pass MOD10 check or province of health card in OLIS is not Ontario)

• Patients who had an MCKC visit (i.e., numerator) during the 1-year follow-up period are assigned to an RRP based on where they had their first MCKC visit after meeting MCKC eligibility.
• Patients who did not have an MCKC visit during the 1-year follow-up period are assigned to an RRP based on their nephrologist’s RRP affiliation(s)*.

*RRP-affiliated nephrologists included in the methodology include the following:

• Nephrologists who practice or practiced at an RRP as well as internal medicine physicians trained in and who practice or practiced nephrology at an RRP
• Any physician trained in and practicing nephrology confirmed by a RRP as previously or currently working for the RRP
• Clinical associates and clinical scholars who practiced or practice at an RRP
• Nephrologists who practice as locums where locum RRP start and end dates were reported

Nephrologists excluded from the methodology include the following:

• Nephrologists or physicians trained in nephrology who practice in the community or privately, but who were not identified as affiliated with an RRP
• Fellows and trainees
• Pediatric nephrologists
• Nephrologists who practice as locums where locum RRP start and end dates were not reported
• Physicians or nephrologists reported by an RRP where no College of Physicians and Surgeons of Ontario (CPSO) number was available

Note: The term MCKC visit(s) includes CRC visit(s).