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BC Children's Hospital Renal Program
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Dr. Janis Dionne Medical Director, Pediatric Kidney Services, BC Renal Gia da Roza UBC Integrated Sciences summer student Marisa Catapang Project Manager
The most rewarding aspect of working on my project has been the knowledge that I am contributing to an initiative that can provide so many different benefits to patients, families, physicians, and the health care system. If implemented, the clinical pathway to treat pediatric hypertension could help physicians diagnose patients more accurately, reduce the burden of testing on patients and families, and reduce unnecessary cost to the system.
Featured Work
A novel clinical pathway for pediatric hypertension aims to reduce unnecessary testing
Pediatric hypertension is a growing concern with 1 in 20 children having high blood pressure. Left unchecked, pediatric hypertension increases the risk of cardiovascular and kidney disease later in life. Compared to adults, children are more likely to have a cause identified for their hypertension. In fact, more than 50% of pediatric hypertension will have a secondary cause. Unfortunately, there is a lack of available evidence about the usefulness of different diagnostic tests, which often results in significant practice variation and unnecessary investigations.
In an effort to standardize care and minimize practice variation, the Pediatric Nephrology Clinical Pathway Development Team at BC Children’s Hospital is building an evidence-based, multidisciplinary clinical pathway for the diagnosis and management of pediatric hypertension. This marks the third pathway undertaken by the team to support the care of children with the most commonly seen kidney conditions throughout the province.
Using the results from a 15-year historical practice audit, and with the help of a pediatric nephrology fellow and a UBC Integrated Sciences summer student, the team has identified which investigations are most helpful for diagnosing the cause of the hypertension and assessing the patient’s cardiovascular risk. They also analyzed the potential cost savings associated with adopting a standardized clinical pathway into care findings. They found that limiting initial testing to only the most helpful diagnostic tests saves hundreds of dollars per patient for the provincial health care system and minimizes unnecessary testing for children and families across BC.
Despite initially being a local initiative, the team hopes the pathway’s impact will extend throughout the province and across the country. If these results are incorporated into future pediatric hypertension guidelines and/or health system reform initiatives, such as the “Choosing Wisely Canada” campaign for reducing unnecessary testing in health care, the clinical pathway has the potential to improve the care of children with pediatric hypertension across Canada.
Web info & resources:
Other Highlights
• Presentation of the hypertension pathway investigation results at the 2022 International Pediatric Nephrology
Association (IPNA) conference, garnering early interest, feedback, and support for this work • Engagement and partnership with pediatricians to ensure broad and balanced multidisciplinary input for the pathway’s proposed recommendations • Creating patient- and physicianfocused educational handbooks for the diagnosis and management of pediatric hypertension (in progress)
bcchr.ca/nephrology bcchildrens.ca/our-services/clinics/renal-program
