Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway.

Area of Science:

• Pediatric Nephrology
• Clinical Pathway Implementation
• Healthcare Standardization

Background:

• The British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was established in 2013 to standardize care for pediatric nephrotic syndrome (NS).
• Children in BC receive nephrology care at BC Children's Hospital (BCCH) and various regional clinics.

Purpose of the Study:

• To compare induction therapy and clinical outcomes for children with NS treated at BCCH versus regional clinics post-CNSCP implementation.
• To assess practice variations in pediatric nephrotic syndrome care within British Columbia.

Main Methods:

• A retrospective cohort study included children aged 1-17 with new-onset NS from 2013-2019, with at least 12 months follow-up.
• Exclusion criteria included non-minimal change disease, steroid resistance, incomplete induction, or <6 months pathway treatment in the first year.
• Clinics were categorized as BCCH or regional (Surrey, Prince George, Kelowna).

Main Results:

• No significant differences were observed in induction prednisone exposure, annualized relapse rate, or frequently relapsing courses between BCCH and regional clinics.
• Similar numbers of first-year clinic visits and dietitian-reviewed food records were noted.
• A higher proportion of children at BCCH received recommended ophthalmology surveillance (87% vs. 59%).

Conclusions:

• The CNSCP has led to comparable care and similar outcomes for children with NS at BCCH and regional clinics.
• The study indicates minimal practice variation in nephrotic syndrome management across BC since pathway implementation.
• Ophthalmology surveillance may require further attention in regional settings.