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Type: Journal article
Title: Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative
Author: Harvey, G.
Oliver, K.
Humphreys, J.
Rothwell, K.
Hegarty, J.
Citation: International Journal for Quality in Health Care, 2015; 27(1):10-16
Publisher: Oxford University Press (OUP)
Issue Date: 2015
ISSN: 1464-3677
Statement of
Gill Harvey, Kathryn Oliver, John Humphreys, Katy Rothwell, and Janet Hegarty
Abstract: 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.
Keywords: chronic kidney disease
evidence-based guidance
improvement collaborative
primary care
Rights: © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: 10.1093/intqhc/mzu097
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