Return on investment of the diabetes foot care clinical pathway implementation in Alberta, Canada.

AIMS: Based on best practices, the diabetes foot care clinical pathway (DFCCP) has been developed and implemented in several clinics in Alberta, Canada. We performed a return on investment (ROI) analysis of this implementation. METHODS: We used a cohort design comparing both cost and return (in terms of reduced health services utilization, HSU) between diabetes patients who were exposed and who were unexposed, to the intervention. We used a difference-in-difference approach and a propensity-score-matching technique to minimize biases due to differences in demographic and clinical characteristics between two cohorts. We used a 1-year time-horizon and converted all costs/savings to 2019 Canadian dollars (1 CA$ ~= 0.75 US$). RESULTS: The intervention helped avoid $3500 in costs of HSU per patient-year. Subtracting the intervention cost of $500, the net benefit of intervention was $3000 (ranged $2400-$3700) per patient-year. The ROI ratio was estimated at 7.4 (ranged 6.1 to 8.8) meaning that every invested $1 returned $7.4 (ranged $6.1-$8.8) for the health system. The probability of intervention being cost-saving ranged from 99.5-100%. CONCLUSIONS: The implementation of DFCCP in Alberta is cost-saving. A continuation of the pathway implementation at studied clinics and a spread to other clinics are recommended.

Nurse practitioners in the Northern Alberta Renal Program.

The presence of nurse practitioners (NPs) in nephrology is not a new concept; literature out of the United States documents their existence quite well Since 1973, the collaboration of NPs and nephrologists has provided cost-effective care for dialysis patients and an alternative for health authorities anticipating a nephrologist shortage. Integration of NPs ensures high-quality, cost-effective, patient-focused care. In 1995, NPs began their integration into the Canadian nephrology field and, in 2004, the Northern Alberta Renal Program (NARP) hired its first nurse practitioner. Currently, there are five NPs who work collaboratively with nephrologists to manage and co-ordinate nephrology care. This article will review the history of NPs in Canada and the introduction of NPs in NARP.

Evaluation of an anemia algorithm in chronic hemodialysis patients.

Although anemia is a common complication of chronic kidney disease, practice variability in its management continues to exist. In an effort to standardize management, the Northern Alberta Renal Program implemented an anemia algorithm, the "Anemia Protocol." A cohort design was used to evaluate the effectiveness of the "Anemia Protocol" in 98 patients three months pre-implementation and three and six months post- implementation. Clinical outcomes of hemoglobin levels, iron indices, erythropoietin and iron dosages, and its associated costs, were compared pre- and post-implementation of the algorithm. This study did not show significant change in anemia or anemia management pre- versus post-implementation of the "Anemia Protocol" in the Northern Alberta Renal Program. However, this is not to imply that algorithms are not useful in clinical settings. Anemia algorithms are invaluable in standardizing management and limiting practice variability, but to ensure that intended clinical outcomes are achieved, algorithms need to be regularly evaluated and revised as necessary.