Abstract
Background: The Northern Territory (NT) has a high burden of chronic kidney disease (CKD) and related chronic conditions, which disproportionally impacts First Nations people. The Territory Kidney Care project aims to improve clinical care for people with CKD and related chronic conditions through electronic health record-based clinical decision support. This thesis focuses on the development, validation, and modelled cost-effectiveness of Territory Kidney Care as a clinical decision support tool.Methods: A systematic review of chronic disease clinical decision support interventions was conducted to support the development of Territory Kidney Care clinical decision support tools. To validate algorithms used within the clinical decision tool, an accuracy study was conducted to compare Territory Kidney Care algorithm-derived diagnosis for CKD and related chronic conditions against clinician diagnosis. To estimate the cost-effectiveness of Territory Kidney Care clinical decision support tool, a NT-wide CKD costing study and modelled cost-effectiveness study was conducted.
Results: Key results are as follows:
• The systematic review found that the effectiveness and cost-effectiveness of clinical decision support is highly heterogeneous, depending on context. Barriers and enablers to the uptake of clinical decision support include clinical, user, external context, and technical factors.
• The algorithm accuracy study showed that Territory Kidney Care electronic phenotype algorithms had a 93% sensitivity for detecting CKD at any stage (stages 1 to 5), and a specificity of 73%.
• In the CKD costing study, total annual healthcare costs were 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).7
• A Markov model was developed to project future costs and outcomes for people living with CKD in the NT. The modelled cost-effectiveness study showed that compared to usual care, Territory Kidney Care as a clinical decision support tool for early intervention, had an incremental cost-effectiveness ratio of $3,427 per quality-adjusted life years gained ($96,684 per patient avoiding kidney replacement therapy, $30,086 per patient avoiding death).
Conclusion: The health informatics component of this thesis contributed to the clinical decision support development and algorithm validation of Territory Kidney Care. The health economics component of this thesis showed that Territory Kidney Care clinical decision support is likely to be highly cost-effective in improving CKD identification and management in the Northern Territory
| Date of Award | Jul 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Gill Gorham (Supervisor), Alan Cass (Supervisor), Asanga Abeyaratne (Supervisor) & Kirsten Howard (Supervisor) |