Value-driven consultations in follow-up care of chronic kidney disease
PhD candidate: Jan-Willem de Jong
Chronic kidney disease (CKD) follow-up care often relies on routine repeat consultations, even when laboratory results show no medical necessity. At Isala, 18% of CKD patients appeared not to require an outpatient visit based on lab values alone. The WACHT-NIET project (Value-Driven Consultations in Personalized Kidney Care Pathways) aims to develop and evaluate an integrated invitation and scheduling system for tailored chronic care consultations.
In collaboration with general practitioners, patients, and the University of Twente, we will design a structured triage approach combining laboratory results, clinical relevance, risk of disease progression, and patient preferences. After blood sampling, patients complete a short questionnaire assessing symptoms and consultation needs. Physicians review this information alongside laboratory outcomes. A consultation is scheduled only when medically indicated or explicitly desired by the patient.
A mathematical optimization model will support scheduling by prioritizing patients with demonstrated consultation needs, ensuring short access times (within one week) for those requiring care. Following development, the system will be implemented and evaluated over 3–6 months in nephrology outpatient care. Outcomes include patient travel burden, number of appointments, access times, workforce efficiency, and patient satisfaction.
We expect to reduce repeat consultations by approximately 20%, thereby increasing capacity and improving accessibility. By aligning care with medical necessity and patient preference, WACHT-NIET contributes to more efficient, patient-centered, and sustainable chronic care. The approach has strong potential for broader implementation in other chronic conditions, such as diabetes and pulmonary disease.
External supervisors:
- Dr. Joris van Dijk (Isala)
- Joan Doornebal (Isala)