Full Report

Decision support
Recommendation #4: Integrate the use of
evidence-based standardized clinical practice
guidelines (CPGs) for other chronic diseases.
Recommendation #5: Establish clear
guidelines and pathways for patient consent
and information sharing.
The value of decision support
CDM literature indicates that healthcare providers need
a range of decision support tools to enable expert,
evidence-based and timely clinical management and
self-management support. These tools include CPGs,
which are useful when embedded in daily practice
and updated regularly to ensure they keep pace
with evolving best practice. 18 CPGs are also helpful
self-management tools for people living with chronic
conditions. Patients who discuss CPGs with their care
teams and integrate them into their care plans are
more likely to follow medication regimes, change
unhealthy behaviours and agree to recommended
tests and screenings. 19
The renal improvement project demonstrated that the
integration of CPGs delivers significant outcomes in a
relatively short period of time. The use of CPGs helped
identify patient populations, properly manage referrals
and intake, and create standardized practice (Table 3).
Given preliminary success of the renal CPGs, the Department
should assess other chronic disease areas that could
benefit from adapting the guidelines or undertaking a
similar evidence-based development process.
Conditions for spread and scale
CDM literature suggests that implementation of
decision support and clinical information systems
should take place only when self-management support
has been established and fundamental changes
have been made to delivery system design. 21 Future
costs will likely be incurred to establish appropriate
staffing support and a patient registry to collect and
monitor patient data; however, developing standardized
CPGs for other disease areas could deliver added
efficiencies and help offset future costs while focusing
on chronic disease prevention and management. The
Department’s CDM project has made measureable
progress toward meeting these conditions; namely by
establishing territory-wide renal CPGs, and through an
agreement to spread SMS as a standardized approach
to patient care.
Territorial Guideline Development
When Department staff were seeking endorsement for
the renal guidelines, it became obvious that there was no
formal process in place to approve and endorse Clinical
Practice Guidelines for use throughout the territory. Having
witnessed the preliminary improvements achieved
by the renal CPGs, it was anticipated that CPGs and
standards would be developed in the future that would
also require formal endorsement prior to implementation.
In order to standardize and streamline this process,
the Department has created the Clinical Practice Steering
Committee, whose membership includes representation
from the Medical Directors and Nursing Leadership
Forums, Office of the Chief Public Health Officer, clinicians,
and Department staff. This committee will work
to provide a coordinated and centralized approach for
the approval of clinical standards, protocols and practice
guidelines across the NWT.
Evidence shows that the use of CPGs can slow
the progression of chronic kidney disease and deliver
significant cost savings over time. 20 CPG implementation
was largely achieved within current resources
and with significant use of staff time.
Making the Case for Change
16