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Expert Systems in Renal Disease

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 Variance. Referral variance

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Expert Systems in Renal Disease

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  1. Expert Systems in Renal Disease Kent Renal ServiceUniversity of KentSalford Hospital Chris Farmer Bernhard Klebe Jean Irving Donal O’Donoghue Paul Stevens Roger Cooley Rachel Middleton Helen Hobbs

  2. Referral Variance Referral variance Corrected for age, gender, ethnicity and population Extremal Quotient 52.72 +2.0 SD 0.0 Farmer C, Hobbs H, Klebe B, Stevens P -2.0

  3. Referral Rates 2003-2006 2003 2004 2005 2006

  4. Proportion of Referrals Seen Percentage 2005 2006

  5. 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 (4.7>90) ml/min John RI, Farmer CK, Abbs I, Stevens PE

  6. Intervention in the Last Year * * Denotes number of biopsies performed ever

  7. 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

  8. 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 Provided there is a robust follow up arrangement

  9. UK Referral Guidelines

  10. UK Referral Guidelines 2558

  11. Referral Rates 2003-2006 2003 2004 2005 2006

  12. Referral Rates 2003-2006 2003 2004 2005 2006

  13. Structured delivery of care Intensive Management ARF Stage 5 Increasing Level Of Care Needed Hospital Based Care Stage 4 Unstable 3 Immunosuppressed Community based care Stage 4 (stable) Hypertension Stable Stage 3 Stage 1 or 2 At Risk Populations

  14. 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

  15. General Practice Database Systems Patient Reports Decision Support Data Extraction MIQUEST Expert System Database Reporting Tool Complete Database Study Data

  16. General Practice Database Systems Patient Reports Decision Support Data Extraction MIQUEST Expert System Database Reporting Tool Complete Database Study Data

  17. General Practice Database Systems Patient Reports Decision Support Data Extraction MIQUEST Expert System Database Reporting Tool Complete Database Study Data

  18. General Practice Database Systems Patient Reports Decision Support Data Extraction MIQUEST Expert System Database Reporting Tool Complete Database Study Data

  19. Treatmentid varchar (20)code varchar(30)date datepracid inttype int Proteinuriaid varchar (20)Codedate datevalue intpracid int Actionsactionid intaction varchar(30) Creatinineid varchar (20)date datevalue intpracid int ReportedGfrid varchar (20)date datevalue floatpracid int Bpid varchar (20)date datesystolic intdiastolic intpracid int Calciumid varchar (20)date datevalue floatpracid int Hbid varchar (20)date datevalue floatpracid int Phosphateid varchar (20)date datevalue floatpracid int Potassiumid varchar (20)date datevalue floatpracid int Pthid varchar (20)date datevalue intpracid int Knownid varchar (20)code varchar(30)date datepracid int B12id varchar (20)Codedate datevalue intpracid int DecisionsdecisionCode intrubric varchar(30) Resultid varchar (20)date datestage intexitno intpracid int RecommendationsexitNo intrecommendation varchar(500) FurtherActionid varchar (20)date dateactionid int pracid intdone boolean PCR id varchar (20)date datevalue intpracid int Triglycerideid varchar (20)date datevalue intpracid int Proteinuriaid varchar (20)Codedate datevalue intpracid int Cholesterolid varchar (20)Codedate datevalue intpracid int HbA1cid varchar (20)date datevalue intpracid int Glucoseid varchar (20)date datevalue intpracid int Practicepracid intname varchar(30) Diabeticid varchar (20)code varchar(30)date datepracid int DiabeticRubriccode varchar(30)rubric varchar(30) Gfrid varchar (20)date datevalue floatpracid int Populationpracid intpopulation intdate date Categorytype intcategory varchar(30) Drugcode varchar(30)rubric varchar(200) Referralid varchar (20)code varchar(30)date datereferralType intpracid int KnownRubriccode varchar(30)rubric varchar(30) GPDecisionid varchar (20)date datepracid intdecisionCode int Patientid varchar (20)pracid intsex varchar(6)dob dategp varchar(8)regDate date Tables created by SetupDatabase and filled by MiqReader. (may decide not to keep this – recalculable) Initially to indicate clinic attendance Tables are linked by id and pracid to patient table.

  20. General Practice Database Systems Patient Reports Decision Support Data Extraction MIQUEST Expert System Database Reporting Tool Complete Database Study Data

  21. 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

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