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Sustainable Health and Green Care. Donal O’Donoghue National Clinical Director for Kidney Care. Working for Better Kidney Care. Green Nephrology Summit London Wednesday 26 th September 2012.

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Sustainable health and green care

Sustainable Health and Green Care

Donal O’Donoghue

National Clinical Director for Kidney Care

Working for Better Kidney Care

Green Nephrology Summit

London

Wednesday 26th September 2012


Environmentally sustainable health and social care scoping review naylor and appleby march 2012

“Some service areas are already leading the way. For example, Green Nephrology includes a network which brings together clinicians, patients, renal technicians and industry partners.”

Environmentally sustainable health and social care: scoping review Naylor and Appleby, March 2012


Sustainable health and green care

“Quality is the only organising principle of the NHS” example, Green Nephrology includes a network which brings together clinicians, patients, renal technicians and industry partners.”

Timely

Efficient

Safe

Effective

Patient Centred

Equitable

Sustainable


Vascular disease one event leads to another reach registry
Vascular Disease – One Event Leads to Another (REACH Registry)

  • CKD

  • MI Risk

  • 2 x greater risk

  • Stroke risk

  • Up 50%

  • Original Event = Stroke

  • MI Risk

  • 2-3 x greater risk

  • Stroke Risk

  • 9 x greater risk

Diabetes

(type 2)

Because of the increased risk associated with diabetes, it should be considered a cardiovascular risk equivalent to a non-diabetic patient with previous MI

  • Original Event = MI

  • MI Risk

  • 5-7 x greater risk

  • Stroke Risk

  • 3-4 x greater risk

  • Original Condition = PAD

  • MI Risk

  • 4 x greater risk

  • Stroke Risk

  • 2-3 x greater risk


Disuse disability spiral
Disuse-Disability Spiral Registry)

Painter (1996)



Sustainable health and green care

Value Registry)

Waste

Value

Waste


Value in health care porter m nejm 363 2477 2010 lee nejm 363 2481 2010
Value in Health Care Registry)(Porter M: NEJM 363:2477, 2010, Lee: NEJM:363:2481, 2010)

“Value should always be defined around the consumer… and the creation of the value for patients should determine the rewards for all other actors in the system.”


Value in health care porter m nejm 363 2477 2010 lee nejm 363 2481 20101
Value in Health Care Registry)(Porter M: NEJM 363:2477, 2010, Lee: NEJM:363:2481, 2010)

“Measurement of value is challenging…the critical first step is measurement. Provider organisations need to capture data on outcomes that matter to patients and carers.”


Results of public opinion survey
Results of Public Opinion Survey: Registry)

Source:

Ipsos MORI


Trends in late referral by year
Trends in Late Referral by Year Registry)

Late referral defined as ≤3 months before RRT start

Data from Canadian, UK and ANZDATA Renal Registries


Sustainable health and green care

Demand for renal replacement Registry)

therapy continues to increase

but incident rates appear to be

reaching a plateau or falling

Prevalent patients by treatment

RRT incident rates


Sustainable health and green care

The mean eGFR at initiation of RRT is rising Registry)

The mean eGFR at initiation of RRT in 2009 in the UK was 8.6

The mean eGFR at initiation of RRT in 2008 in the US was 11.1

Percent distribution at initiation by eGFR



Shared decision making
Shared Decision Making: Registry)

The care team communicates to the patient personalised information about the options, outcomes, probabilities and scientific uncertainties of the various treatments.

“is a fundamental part of care planning and promotes the best choice in what otherwise can be a complex and overwhelming situation.”

The patient communicates his or her values and relative importance he or she places on the potential benefits and harms.

http://sdm.rightcare.nhs.uk/


Patient decision aids
Patient Decision Aids Registry)

http://sdm.rightcare.nhs.uk/



Sustainable health and green care

Aerobic Exercise Training: Registry)

Haemodialysis bed cycle ergometer training


Sustainable health and green care

5% of transport emissions in the UK are estimated to be accounted for by healthcare facilities

Environmentally sustainable health and social care: scoping review – Naylor and Appleby, March 2012


Sustainable health and green care

5% of transport emissions in the UK are estimated to be accounted for by healthcare facilities

Ingredients in a steak and kidney pie served in one hospital had travelled a total of 31,000km

Environmentally sustainable health and social care: scoping review – Naylor and Appleby, March 2012


Motivate and inspire
Motivate and inspire … accounted for by healthcare facilities

Influence key levers and mechanisms to support uptake …

Legislation, Inspection, Incentives

Performance management of new Commissioning Consortia through the Outcomes Framework

National clinical audit

Education/ accreditation/ CPD e.g. via Royal Colleges and professional bodies

Workforce development

Promoting evidence into practice – guidelines

Developing the evidence base

Patient stories


Sustainable health and green care

“Often change need not be cajoled or coerced. Instead it can be unleashed.”

Kelman, S. (2005) Unleashing Change. A study of organizational renewal in government, Brookings Institution Press; Washington, D.C