When the Ontario Renal Network (ORN ) was created in June 2009, it was tasked with improving the quality of care for people with chronic kidney disease (CKD) in the province and examining how that care is funded.
But before the network could carry out this mandate from the Ministry of Health and Long-Term Care (MOHLTC), it had to know more about the patients being treated.
The starting point was the Ontario Renal Reporting System, essentially a provincial version of CIHI’s Canadian Organ Replacement Register (CORR). This data allowed a team of clinical and program experts to classify CKD patients into seven clinically meaningful categories with distinct care and resource requirements.
“Once we categorized the patients within CORR, we identified what services should be provided for those patients and estimated what the cost should be,” says Graham Woodward, ORN’s Director of Planning, Reporting and Evaluation.
Up until now, it has been a bit of a guessing game. At the start of every year, each of the province’s 26 hospital-based CKD programs would estimate the total number of renal services it was going to provide in the coming year, and each service had a funding amount attached to it.
“As a physician who cares for patients with chronic kidney disease, I cannot over-emphasize how important this work is,” states Dr. Judith Miller, Medical Director of ORN. “Firstly, the funding rates were devised in 1996, and have not been modified since. Secondly, funding linked to services rather than patients detracts from our ability to assess the outcomes of care and does not facilitate a focus on quality. I envision that our funding model will result in better patient care, will promote our focus on quality and will provide hard evidence on which patterns of care result in better outcomes.”
Although CORR captures patient information on transplants and dialysis treatment, it doesn’t include other activities associated with a patient’s care, so the network took things a step further by linking to records in CIHI’s National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database (DAD) .
“This gave us a better idea of how these patients use ambulatory and inpatient services,” Woodward says. “It helped paint a clearer picture of the intensity of care these patients require.”
Woodward says the ORN will continue to work with CIHI, the Ontario MOHLTC and data abstractors in hospitals to make simple modifications that will result in better information for funding and decision-making.
The first steps have been taken toward implementing a patient-based funding model for CKD in Ontario. Dr. Peter Magner, the Chair of the ORN funding committee, is looking forward to removing current inequalities between hospitals so that they will be funded similarly based on the care that a specific patient type is expected to receive. Because the payment is based on recommended best practice, he expects to see improved consistency in the quality of kidney care delivered across the province.
“The primary objective is to have the money follow the patient and pay for quality care,” he says. “This will allow for better planning and accountability. We’ll know what we’re paying for.”
In all of this, data has made a difference: “We couldn’t have done it without the CIHI data,” Woodward says.