Evaluation of a mentorship program to support chronic kidney disease care.

PROBLEM ADDRESSED: Primary care providers (PCPs) are ideally situated to detect and manage patients with chronic kidney disease (CKD), but they could use more support from nephrologists to accomplish this. OBJECTIVE OF PROGRAM: To improve early detection and management of CKD in primary care, and improve referrals to nephrologists through education and greater partnership between nephrologists and PCPs. PROGRAM DESCRIPTION: Nephrologists provided mentorship to PCPs in Ontario through a collaborative relationship. Nephrologists provided PCPs with educational orientation sessions and need-based advice on patient cases. CONCLUSION: Primary care providers with more than 5 years of experience were more likely to use the program. Primary care providers expressed high satisfaction with the program and reported that it was effective in supporting routine CKD screening efforts, management of early CKD, appropriate referrals, and building a collaborative relationship with nephrologists.

Implementation of an agency to improve chronic kidney disease care in Ontario: lessons learned by the Ontario Renal Network.

In 2009, Ontario's Ministry of Health and Long-Term Care initiated the transfer of oversight and coordination of chronic kidney disease (CKD) care to the Ontario Renal Network (ORN) under the auspices of Cancer Care Ontario (CCO). The aim was to replicate the quality improvement and change management practices used for cancer control within CKD. Much of the ORN's first three years were dedicated to building the infrastructure necessary to bridge the gap between provincial policy and clinical practice. This article explores the accomplishments, challenges and lessons learned over that period. The results, which are applicable to the management of chronic diseases in Ontario, Canada, and internationally, confirm that sustainable change takes time and requires strong leadership, transparency, accountability and communication, supported by a solid foundation of data and evidence.

Variation in emergency department visits for conditions that may be treated in alternative primary care settings.

The purpose of this report is to examine Ontario's geographic variation in emergency department (ED) visits for conditions that may be treated in alternative primary care settings. We studied all visits to Ontario EDs in 2002/03 and calculated county-specific age-standardized rates. Overall in Ontario, there were 3174 ED visits per 100,000 population aged 1-74 for conditions that could be treated in alternate primary care settings, but rates varied widely across counties. They were higher in rural counties with rates up to 7-fold higher than the provincial average. Urban counties had lower rates, some were less than one-third of the provincial average. Further research is needed to determine the relationship between ED utilization and primary care capacity.

Under-reporting of live births in Ontario: 1991-1997.

OBJECTIVE: To examine unregistered births in Ontario and consider related factors, including adoption of administrative fees for birth registration. METHODS: Documents from both the parents and the attending physician are required for births to be entered into Ontario's live birth database. Our study used data from the Ontario Registrar General to look at the prevalence and characteristics of unregistered births, and a survey of municipal clerks to identify municipalities charging fees for parental documentation. RESULTS: The percentage of births going unrecorded increased threefold from 1991 to 1997. The odds of an unregistered birth were higher for teenage mothers, low birthweight babies, and mothers residing in a municipality that charged birth registration fees. CONCLUSION: The introduction of registration fees by some municipalities appears to account for an increase in unregistered births. It is recommended that the Ontario Registrar General work to remove financial and administrative barriers that compromise birth statistics.