Expert Systems in Renal Disease enal Association Education在肾脏疾病肾协会教育专家系统.pptVIP

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Expert Systems in Renal Disease enal Association Education在肾脏疾病肾协会教育专家系统.ppt

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Expert Systems in Renal Disease enal Association Education在肾脏疾病肾协会教育专家系统

Expert Systems in Renal Disease Kent Renal Service University of Kent Salford Hospital Chris Farmer Bernhard Klebe Jean Irving Donal O’Donoghue Paul Stevens Roger Cooley Rachel Middleton Helen Hobbs Referral Rates 2003-2006 Proportion of Referrals Seen Outpatient Activity 623 forms assessed 53.2% Male Median Age 59 (16-93) Median SCr 124 ?mol/L (35-832) Median calculated GFR 50.4 (4.790) ml/min Intervention in the Last Year Possible to identify patients who could be discharged based on: Stable Chronic Kidney Disease Blood Pressure under 140/85 No alteration in treatment in the past year 29.8% of patients followed up Possible to identify patients who could be discharged based on: Stable Chronic Kidney Disease Blood Pressure under 140/85 No alteration in treatment in the past year 29.8% of patients followed up UK Referral Guidelines UK Referral Guidelines Referral Rates 2003-2006 Referral Rates 2003-2006 Structured delivery of care Expert System in Kidney Disease Identify patients requiring intensive management Facilitate robust follow up of patients discharged from hospital based care Provide patient specific guidance for further investigations of patients with CKD Manage stable chronic kidney disease in the community Development Recruitment of GP Surgeries 8 Practices 100,000 people registered with their GP Development of decision support tool and secondary checking of outputs Development of “expert” areas such as rate of decline of renal function Implementation and checking in a second UK region Cluster randomised controlled trial * * Referral Variance SD +2.0 0.0 -2.0 Referral variance Corrected for age, gender, ethnicity and population Extremal Quotient 52.72 Farmer C, Hobbs H, Klebe B, Stevens P 2003 2004 2005 2006 2005 2006 Percentage John RI, Farmer CK, Abbs I, Stevens PE * * Denotes number of biopsies performed ever Provided there is a robust follow up arrangement Action Per Million NEOERICA Refer 36 5 Stage 5 Refer 60 9 Anoth