predicting the growth in dialysis services in ontario, canada 2007-2011课件

CONFIDENTIAL NOTFORDISTRIBUTION PredictingtheGrowthinDialysisServicesinOntario Canada2007 2011 RobQuinnMDFRCPCClinicalAssociateSunnybrookHealthSciencesCentreCIHRInstituteforHealthServices PolicyResearch IHSPR Fellow PhDCandidateDepartmentofHealthPolicy Management Evaluation UniversityofTorontoDecember13 2007 2 OutlineofPresentation Background Renal101 DataSources TerminologyBriefOverviewofStatisticalMethods TheFirst90Days ProvincialResultsMakingSenseofDataattheLHINLevelInterpretiveCautionsConclusions 3 HowPeoplewithKidneyFailurePresent SlowlyprogressivechronickidneydiseaseOftenfollowedinpredialysisclinicsUsuallystartasoutpatientsAcutekidneyinjuryrequiringdialysisDevelopkidneyfailureafteracuteillnessHospitalized highresourceutilization highmortalityrate highrateofrecoveryAcutekidneyinjuryinsettingofchronickidneydiseasePrecipitousdeclineinkidneyfunctionduetoacuteillnessUsuallyhospitalized intermediatemortality likelihoodofrecovery 4 TreatmentConsiderations TransplantationPreferredtherapy cheapest bestoutcomes LimitedsupplyoforgansHemodialysis HD HighestannualoperatingcostsPerformedinoutpatientunits capitalinvestment PeritonealDialysis PD Lowerannualoperatingcostsvs HDCapitalcostsminimalHometherapy CanadianInstituteforHealthInformation CORRAnnualReport 2006 5 TreatmentofKidneyFailureinCanada 31 000patientsrequiredrenalreplacementtherapy RRT inCanadabyendof2004 49 treatedwithHemodialysis HD 39 alivewithaFunctioningTransplant12 treatedwithPeritonealDialysis PD UnitedStatesRenalDataSystem AnnualReport 2006 6 TheCostofCaringforPatients Caringforpatientswithkidneyfailureisresourceintensive 0 7 ofMedicarepopulationConsume5 ofannualMedicarebudgetPopulationofpatientswithkidneyfailurecontinuestogrowProjectionsoftheneedfordialysisservicesrequiredtoplanforneedforequipment facilities personnel 7 LimitationsofExistingLiterature Onlyincluded chronicdialysispatients Basedonregistrydataanddonotcaptureallpatients 90 dayrule OftenignorepatientswithahistoryoftransientdialysistreatmentorpriortransplantIgnorestheimpactofpatientswithacutekidneyinjuryrequiringdialysis 8 Objectives IdentifyallpatientswhoreceiveddialysistreatmentintheprovincebetweenJuly1 1998andDecember31 2005Describethedispositionofthiscohort90daysfollowingtheinitiationoftherapyUsetimeseriesanalysistomodelhistoricaldataandmakeprojectionsabouttheneedfordialysisservicesintheprovinceTodeterminetheproportionofdialysisactivitythatwasattributabletohospitalizedpatientswithacuterenalfailuretoquantifythepotentialimpactofthisgrouponresourceutilization 9 DataSources RegisteredPersonsDatabase RPDB OntarioHealthInsurancePlan OHIP physicianbillingclaimsOntarioDiabetesDatabase ODD CanadianInstituteforHealthInformation CIHI DischargeAbstractsDatabase DAD 10 DataSources AdministrativeHealthDataCollectedforpurposesotherthanresearchAlreadyexists nofurtherexpensetocollectAllowsaccesstoinformationforentireprovince canhighlightregionaldifferencesOftenusesurrogatemeasuresforvariablesofinterestValidationrequiredTimedelays 11 DataSources LHIN10 SouthEast AlternativefundingarrangementPrimaryclinicaldataprovidedonprevalentoutpatientHDandPDpatientsBillingdatalooksreliablebyJuly Sept2005AssumedrateofdialysisinKingstonhadaconstantrelationshipwiththeprovincialrateGeneratedexpectedvaluesofvariablesfortimeperiodofinterestinordertomakeforecasts 12 Terminology IncidentDialysisPatients AllNEWdialysispatientsduringthetimeperiodofinterest 13 Terminology PrevalentPatients ALLPATIENTSthatyouareprovidingdialysistherapytoatagivenpointintime 14 Terminology PrevalentOutpatients PrevalentOutpatients HDPrevalentOutpatients PDPatientsthataretheresponsibilityoftheoutpatientdialysisunitsYouneeda spot forthem 15 StatisticalAnalysis Allpatientswhoreceivedatleast1dialysistreatmentfollowedfor90daysWethendescribed DistributionofinitialtreatmentmodalitiesProportionofpatientsstartinginhospitalProportionofpatientsrequiringoutpatienttreatmentDisposition90daysafterstartingdialysis 16 StatisticalAnalysis Thenumberofpatientsrequiringtreatmentwasdeterminedatregularlyspaced 3 monthintervalsTotalnumberofincidentdialysispatientsTotalnumberofprevalentpatientsTotalnumberofprevalentoutpatientsTotalnumberofprevalentoutpatientHDTotalnumberofprevalentoutpatientPD 17 StatisticalAnalysis Timeseriestechniqueswereusedtomodelthehistoricalincidenceandprevalencecounts4differentTimeSeriesmodelsconstructedforeachvariableinSASandexaminedfor fit AutoregressiveIntegratedMovingAverage ARIMA StepwiseAutoregressiveExponentialSmoothingWinter sMethod seasonality Modelsthenusedtoforecastto2011 18 ValidityofResults NogoldstandardtocompareagainstComparedprojectionsfrompreviousreporttoobserveddataExternalvalidationCompareddatatomostrecentCORRreport 19 RESULTS TheFirst90Days 20 InitialFormofDialysisTreatment Basedondatafrom31 679patients Hemodialysis73 PeritonealDialysis12 ContinuousDialysis CRRT 15 21 TheFirst90DaysofDialysis 62 ofallnewpatientsstartdialysisinhospital27 diepriortodischarge63 ofallnewpatientswillgoontorequiretreatmentinanoutpatientdialysisfacility 22 Statusat90Days Dead23 Recovered25 AliveonDialysis52 ImpactofAcuteKidneyInjury Makesup 60 ofnewpatientsCapture48 ofnewpatientsifwaituntil90daystostartcountingpeopleOnlyaccountsfor3 oftheprevalentpopulationatanypointintimeDisproportionateresourceutilizationDivertresourcesfromchronicpopulation 24 RESULTS ProvincialData Incidence Prevalence andModalityDistribution 25 ThenumberofpatientsbeingtreatedwithdialysisatanypointintimeisverypredictableandisgrowinginalinearfashionProjectedtogrowto11 104patientsby2011Confidenceintervals 10 931 11 277 or 1 6 26 Projectionsofprevalentdialysispatientsprovidedbyquarter 27 ThenumberofprevalentoutpatientsbeingtreatedwithdialysisatanypointintimeisalsoverypredictableandisgrowinginalinearfashionProjectedtogrowto10 796patientsby2011Confidenceintervals 10 655 10 938 or 1 3 28 MajorityofprevalentpatientsareonHDsocurveresemblesthatof allprevalentpatients and prevalentoutpatients Projectedtogrowto9 157patientsby2011 85 prevalentoutpatients Confidenceintervals 8 999 9 316 or 1 7 29 PDgrowthnotaspredictable butstillallowsconfidentforecastsProjectedtogrowto1 629patientsby2011 15 ofprevalentoutpatients Confidenceintervals 1 532 1 726 or 5 6 30 Incidencecountsaremorevariable butdemonstratecleartrendProjectedtogrowto1 605patientsperquarterby2011Confidenceintervals 1 415 1 795 or 11 8 31 ProportionofPrevalentOutpatientsTreatedwithPDvs HDbyYear 32 ProvincialData Summary Historical averageannualgrowthratesIncidence4 9 Prevalence7 2 4 000newpatientswillrequireoutpatientdialysiseachyearby2010Nearly11 000prevalentoutpatientswillrequiretreatmentby2011 85 HD Abletomakeconfidentforecastsataprovinciallevelforallvariables 33 AccuracyofProjections ForecastoftotalprevalentdialysispatientsintheprovinceonJan1 2005 Forecastedvalue PreviousReport 8 100Actualvalue 8 063Difference 37patients 0 5 absoluteerror Short termprojectionsveryaccurate 34 ConsistencyofProjections ChangeinforecastoftotalprevalentdialysispatientsinprovinceJan1 2010 Forecastedvalue Lastreport 10 605Forecastedvalue 2007report 10 594Difference 11patients 0 1 Additionalyearofdatahasnotchangedforecastsoutto2010toanysignificantdegree 35 LHINForecasts Fromaplanningperspective Needtoknowtotalnumberofprevalentpatientstounderstandresourcesrequiredtotreatthem totalprevalentpatients Atanygiventime howmanydialysispatientsamItreating 36 LHINForecasts Fromaplanningperspective Needtoknowtotalnumberofprevalentpatientswhoare property oftheoutpatientunits totalprevalentoutpatients Howmanypatientsaremyoutpatientunitsresponsiblefor andhowmanyspotsdoIneedtohave 37 LHINForecasts Fromaplanningperspective Needtoknowmodalitymix PDvs HD inprevalentoutpatientsinordertoplannewHDunits totalprevalentoutpatientHD PD HowmanyoutpatientHDspotsdoIneed 38 LHINData Summary ConfidentinPredictionsTotalprevalentpatients prevalentoutpatientsTotalprevalentoutpatientHDLessConfidentinPredictions SMALLNUMBERSINSMALLLHINS TotalprevalentPDpatientsIncidentpatients 39 40 InterpretiveCautions Identifyindividualsbasedonwheretheylive notnecessarilywheretheyseekdialysistreatmentAnumberofpatientstreatedatagivenprogrammayliveoutsidecurrentLHINboundariesLHIN specificnumbersmaynotreflectpracticeofparticularregionalprogram 41 InterpretiveCautions HDpatientsinclude Short DailyHDNocturnalHDHomeHDPrevalenceofhome basedHDtherapiesvariesfromregion to region 42 OtherConsiderations Impactofaregionaldialysisprogramonresourceconsumptionbeyondtheprovisionofdialysiss