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Background: The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective. Methods: We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model. Results: Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD. Conclusion: The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions. [ABSTRACT FROM AUTHOR]

Background: The burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care. Aim: This paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care. Methods: Building on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system's design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation. Results: We established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events. Conclusion: Disconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care. [ABSTRACT FROM AUTHOR]

Context: Healthcare in the Northern Territory (NT) is complicated by remoteness and transient and dispersed populations. The delivery of healthcare is administered by both government and non-government services, which rely on disconnected information systems. Information gaps limit the effective management of renal patients who may access multiple health services across the NT. Objectives: The development and implementation of the Territory Kidney Care (TKC) clinical support tool intends to bridge the information gap by collating patient summaries using the missing pieces of critical health data from participating health services. This initiative seeks to improve the management and care coordination of patients at risk of, or diagnosed with, CKD and to slow the progression to RRT by synthesising information into a single patient record. Key messages: The collaboration of health services is integral to the successful implementation of TKC and the "two-way" sharing of related data. Since implementation began in 2019, we have established data participation agreements with nine ACCHS and, as of March 2022, there are 352 users of TKC. On average, TKC sends 50 patient summary reports per month, as well as health service reports every six months providing CQI data identifying the proportion of missing CKD diagnosis, proportion missing regular/annual screening for BP and HbA1c. Conclusion: TKC provides an opportunity to bridge the information gap through strong partnerships and two-way data sharing, thereby supporting clinicians to provide the best standards of safe and coordinated clinical care for CKD. [ABSTRACT FROM AUTHOR]

Background: In the Northern Territory, integrated healthcare is challenged by a highly mobile population, siloed health services and lack of a unique identifier. Territory Kidney Care (TKC) is a digital clinical decision support tool that was developed to close this information gap. As patients often have multiple unconnected health records, data linkage is central to the functionality of TKC. Aims: To validate the automatic linkage protocol in TKC, identify false negatives and co-design feedback mechanisms to improve the quality and completeness of patient information. Methods: We examined audit reports to identify potential false negatives where patient records remain unlinked due to mismatch in name, date of birth (DoB), or health record number (HRN). This was checked by searching for corroborating information in source systems (corrected HRN or DoB) and establishing a feedback mechanism with health services. Results: Of the 72159 TKC patients, 38096 (52.8%) had records from multiple systems consisting of 14,703 (20.4%), 18,104 (25.1%) and 5,289 (7.3%) from 2, 3 and ≥4 health systems respectively. 750 (2.0%) patients had multiple unlinked records requiring investigation. We co-designed an efficient and secure process to communicate demographic advice between services with 429 patients subsequently linked, 6 records adjudged never to be linked,144 patient records updated with a universal identifier and 174 awaiting additional information. Conclusion: The TKC data linkage protocol improves the quality and completeness of patient information by enabling almost all available data to be linked, which generates a more comprehensive picture of the patient journey to inform clinical decision making. [ABSTRACT FROM AUTHOR]

Background: First Nation Territorians suffer the heaviest burden of kidney failure in Australia with most living in remote areas at time of dialysis commencement. With limited dialysis services in remote areas, many must permanently relocate, to access treatment. Missing dialysis treatments is not uncommon but the relationship between location of dialysis service and dialysis attendance has not been explored to date. Aim: To examine the relationships between location of dialysis service, dialysis attendance patterns, hospital admissions and emergency department presentations. Methods: Linked hospital and dialysis registry data was analysed using multivariate linear regression and negative binomial regression analyses for 896 First Nation dialysis patients in the NT between 2008-2014. Results: Missing two or more dialysis treatments per month was more likely for First Nation patients attending urban services and this was associated with a two-fold increase in the rate of hospital admissions and more than three-fold increase in ED presentations. When adjusted for age, time on dialysis, region, comorbidities and residence pre-treatment, patients from remote areas dialysing in remote areas, had lower rates of hospitalisations (IRR 0.56; P<0.001) when compared to those who relocated and dialysed in urban areas. Conclusion: There is a clear relationship between the location of dialysis services and subsequent health service utilisation. Our study suggests that low dialysis attendance associated with relocation and care in urban centres can potentially be ameliorated by access to rural and remote services. A rethinking of service delivery policy is warranted if providers are to deliver effective and equitable services. [ABSTRACT FROM AUTHOR]

Background: The Northern Territory (NT) has the highest rates of kidney disease in Australia, with the burden heaviest in remote areas. The high cost of delivering dialysis services in remote areas has resulted in service centralisation and relocation of many people, with patients arguing, poorer health outcomes. Dialysis cost studies have not compared total health care costs associated with treatment in different locations. Objective: To estimate and compare, from a payer perspective, the observed health service costs (all cause hospital admissions, emergency department presentations and maintenance dialysis) of dialysis models in urban, rural and remote locations. Methods: Using diagnostic code cost weights in hospital data sets (2008-2014), we calculated the mean total annual health service costs by dialysis model for 995 patients. Generalized linear modeling with bootstrapping tested the marginal cost differences between explanatory variables to estimate 'low casemix /high casemix' cost scenarios. Results: The mean annual patient hospital expenditure was highest for urban models at $97 928 (SD $21 261) and lowest for remote at $19 584 (SD $4 394). The incremental cost increase of dialysing in an urban area, compared with a rural area, for a relocated person was $5 648 more and increased to $10 785 and $15 118 for remote and very remote areas respectively. Conclusion: When all health service costs are considered, the comparative cost differences between urban and remote models are significantly reduced. This study emphasises the importance of considering all health service costs and cost consequences of dialysis models to effectively inform policy. [ABSTRACT FROM AUTHOR]