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 management tools widespread throughout the world to improve the quality of patient care through a well-organized care continuum and to enhance the patient's "risk-adjusted" outcomes; indeed they could optimize the management of resources. They are particularly effective in the management of patients with chronic degenerative diseases, such as chronic kidney disease, with increasingly incidence and prevalence, with an estimated 11-13% of the population being affected. The aim of this study is to apply the Health Services Research methods to estimate the relationship between need, demand and supply in patients with stage 5 Chronic Kidney Disease (CKD) for, then to describe the definition of a CDCP dedicated to patients in Lazio Region, so to allow an appropriate patient management, to reduce the likely complications and the patients' migration to facilities outside the region.

Methods: The study was conducted in 2017 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 CKD in Roma and in the San Giovanni Addolorata Hospital Trust and we found a drop out in the patients' attendance towards other regions and/or hospitals. So we defined a CDCP to be adopted at the San Giovanni Addolorata hospital.

Conclusions: To define management and care tools to provide adequate, efficient and patient centered care is a nowadays "must", to ensure the sustainability of the Italian NHS, which today is comparable to a "ship that is heading towards a perfect storm".