TY - JOUR
T1 - Improving the identification and management of chronic kidney disease in primary care
T2 - Lessons from a staged improvement collaborative
AU - Harvey, Gill
AU - Oliver, Kathryn
AU - Humphreys, John
AU - Rothwell, Katy
AU - Hegarty, Janet
PY - 2015/2
Y1 - 2015/2
N2 - Quality problem: Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Initial assessment: Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ~30% were estimated to have suboptimal management according to Public Health Observatory analyses. Choice of solution: An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. Implementation: A two-phase collaborativewas implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do- Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Evaluation: Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as amarker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ~2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. Lessons learned: An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention.
AB - Quality problem: Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Initial assessment: Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ~30% were estimated to have suboptimal management according to Public Health Observatory analyses. Choice of solution: An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. Implementation: A two-phase collaborativewas implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do- Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Evaluation: Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as amarker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ~2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. Lessons learned: An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention.
KW - Chronic kidney disease
KW - Evidence-based guidance
KW - Implementation
KW - Improvement collaborative
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=84924536917&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzu097
DO - 10.1093/intqhc/mzu097
M3 - Article
C2 - 25525148
AN - SCOPUS:84924536917
SN - 1040-6166
VL - 27
SP - 10
EP - 16
JO - Quality Assurance in Health Care
JF - Quality Assurance in Health Care
IS - 1
ER -