Quality and management care improvement of patients with chronic kidney disease: from data analysis to the definition of a targeted clinical pathway in an Italian Region

Background: Clinical Diagnostic Care Pathways(CDCP) are widespread throughout the world and they could  improve the quality of patient care through a well-organized care continuum  and could enhance the patient's "risk-adjusted" outcomes; indeed they could optimize the management of resources. They are important especially for the management of chronic degenerative diseases such as chronic kidney disease; for this disease incidence and prevalence is increasing worldwide, with an estimated 11-13% of the population being affected. So the application of a CDCP is much important for its management. Methods: the aim of this study is the creation of a CDCP for patients in Lazio with stage 5 CKD that allows proper patient management with a reduction in the possible complications and patient migration to facilities outside the region. The study was conducted in collaboration between the National Institute of Health, the University of Messina and the S. Giovanni Addolorata Hospital. Results: We analyzed the data for the KCD in Roma and in the San Giovanni Addolarata Hospital and we found a drop out of the patient, probably to other region or however other hospital. So we make a CDCP that has been adopted as a model in the San Giovanni Addolorata hospital and the reduction of outpatient migration and emergency hospital access are currently being monitored. Conclusions: the optimization of patient management and the organization of adequate health care is therefore essential to ensure the sustainability of the Italian NHS, which today is comparable to a "ship that is heading towards a perfect storm".