The role of specialists in managing the health of populations with chronic illness: the example of chronic kidney disease

摘要

Problem Specialty care has been used to manage individual patients at the discretion of generalists but not to drive improvements at the population level. Design Observational longitudinal study. Setting Kaiser Permanente Hawaii, with more than 10 000 members with documented chronic kidney disease. Key measures for improvement Rate of late referrals to nephrologycare, defined as occurring within four months of end stage renal disease and the proportions of patients starting haemodialysis with a mature arteriovenous fistula and starting dialysis in the outpatient setting. Strategies for change Risk stratification of the entire population and unsolicited consultations provided by nephrologiststo generalists, based on patients' risk level, enabled by an electronic population management database.