Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative
Open accessAbstract
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 collaborative was 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 a marker 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.
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In the CKD case, the presence of CKD indicators in the pay-for-performance system in primary care created an incentive for improvement.
“Similarly in the case study of CKD, the presence of CKD indicators in the pay-for-performance system in primary care created an incentive for improvement [21].”
From PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice (2015) · cites this paper as [21]
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- Authors
- Harvey, G., Oliver, K., Humphreys, J., Rothwell, K., & Hegarty, J.
- Affiliations
- University of Manchester (GB)
- Salford Royal NHS Foundation Trust (GB)
- Corresponding author
- Harvey, G.
- Venue
- International Journal for Quality in Health Care
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-12-18
- Volume
- 27
- Issue
- 1
- Pages
- 10-16
- ISSN
- 1353-4505 (ISSN-L)
- 1464-3677
- PMC
- PMC4340270
- OpenAlex
- W2146693675
- Cited by
- 21
- References
- 15
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 1 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 3 · 2015: 3
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- International Journal for Quality in Health Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- chronic kidney disease, CKD detection, CKD management, primary care, blood pressure targets, CKD prevalence, quality improvement, facilitator support, PDSA cycle, general practice
- MeSH terms
- Blood Pressure, Humans, Insurance, Health, Reimbursement, Primary Health Care, Program Evaluation, Prevalence, Practice Guidelines as Topic, Disease Management, Guideline Adherence, Benchmarking, Renal Insufficiency, Chronic, Quality Improvement
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