Clinical analytics

An estimated 23 million people in the United States, nearly 12% of the adult population, have CKD and are at increased risk for progression to kidney failure, as well as cardiovascular-related events. Clinical decision-making for CKD is challenging due to the heterogeneity of kidney diseases, variability in rates of disease progression, and the competing risk of cardiovascular mortality.

The deficit

Although there are proven therapies to improve outcomes in patients with progressive kidney disease, these therapies may also cause harm and add greatly to the cost of care. Currently, there are no widely accepted predictive instruments for CKD progression, and physicians must use expert judgment and heuristics to decide which patients to treat, resulting in risking treatment delays for those who ultimately develop kidney failure or unnecessary treatment in those whose CKD condition does not progress.

Few domains in healthcare offer a clearer opportunity for realization of the Quadruple Aim than care at the end of life. This period is all too commonly marked by aggressive, invasive intervention representing a significant burden to patients, their loved ones, and the broader system of care – yet without commensurate improvement in outcomes or quality of life.

The deficit

Fundamentally, the root cause of this status quo is a deficit in prediction. While a physician may be aware of a patient’s worsening, the variable course keeps the clinical team and the patient focused on the hope of improvement, and hesitant to talk about mortality prediction. But hospice referrals are the rare situation in medicine where the physician needs to “predict mortality within 6 months.” Not only is this prediction difficult one patient at a time, and clinicians have been shown to have low accuracy in doing so, patients and families may not be interested or ready for the conversation.

Despite recent improvements, unplanned hospital readmissions continue to be a massive public health problem in the United States. Readmissions impact up to 3.3 million patients in the US and cost an estimated $26 billion per year, with an estimated $17 billion being potentially avoidable. The Center for Medicare & Medicaid Services (CMS) now publicly reports rates of readmissions, and financial penalties are assessed to hospitals with high readmission rates.

The deficit

The causes for failure to prevent most readmissions are complex. Patient demographics, diet, and medical co- morbidities exacerbate this profound problem. Hospital treatment, medications, and discharge and follow-up processes also appear to have an impact. The actual interaction amongst this vast array of variables is not yet fully understood. Unfortunately, guidelines recommend population-based interventions with little to no consideration of individual patients, and clinicians are provided insufficient knowledge about clinical decision support.

Recognizing the need to predict those most at risk to develop sepsis and reduce the costs associated with their care is vital. Sepsis accounts for 750,000 hospitalizations annually. Annual costs of care for Sepsis in the US equal approximately $20 billion annually, more than any other single disease. The annual mortality rate due to sepsis is between 15% and 30% – with as many as 200,000 deaths in the US alone each year.

The deficit

Sepsis is the leading cause of hospital readmission among the adult population in the US. Severe sepsis and its progression to septic shock have been difficult to predict and treat promptly. Beginning in 2017, the Centers for Medicare & Medicaid services (CMS) began adjusting hospital payments based on the quality of sepsis care. The KenSci solution for Sepsis Prediction allows hospitals and care givers to predict those most likely to develop insepsis care