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Boaz A, Baeza J, Fraser A, Persson E. 'It depends': what 86 systematic reviews tell us about what strategies to use to support the use of research in clinical practice. Implement Sci 2024; 19:15. [PMID: 38374051 PMCID: PMC10875780 DOI: 10.1186/s13012-024-01337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The gap between research findings and clinical practice is well documented and a range of strategies have been developed to support the implementation of research into clinical practice. The objective of this study was to update and extend two previous reviews of systematic reviews of strategies designed to implement research evidence into clinical practice. METHODS We developed a comprehensive systematic literature search strategy based on the terms used in the previous reviews to identify studies that looked explicitly at interventions designed to turn research evidence into practice. The search was performed in June 2022 in four electronic databases: Medline, Embase, Cochrane and Epistemonikos. We searched from January 2010 up to June 2022 and applied no language restrictions. Two independent reviewers appraised the quality of included studies using a quality assessment checklist. To reduce the risk of bias, papers were excluded following discussion between all members of the team. Data were synthesised using descriptive and narrative techniques to identify themes and patterns linked to intervention strategies, targeted behaviours, study settings and study outcomes. RESULTS We identified 32 reviews conducted between 2010 and 2022. The reviews are mainly of multi-faceted interventions (n = 20) although there are reviews focusing on single strategies (ICT, educational, reminders, local opinion leaders, audit and feedback, social media and toolkits). The majority of reviews report strategies achieving small impacts (normally on processes of care). There is much less evidence that these strategies have shifted patient outcomes. Furthermore, a lot of nuance lies behind these headline findings, and this is increasingly commented upon in the reviews themselves. DISCUSSION Combined with the two previous reviews, 86 systematic reviews of strategies to increase the implementation of research into clinical practice have been identified. We need to shift the emphasis away from isolating individual and multi-faceted interventions to better understanding and building more situated, relational and organisational capability to support the use of research in clinical practice. This will involve drawing on a wider range of research perspectives (including social science) in primary studies and diversifying the types of synthesis undertaken to include approaches such as realist synthesis which facilitate exploration of the context in which strategies are employed.
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Affiliation(s)
- Annette Boaz
- Health and Social Care Workforce Research Unit, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK.
| | - Juan Baeza
- King's Business School, King's College London, 30 Aldwych, London, WC2B 4BG, UK
| | - Alec Fraser
- King's Business School, King's College London, 30 Aldwych, London, WC2B 4BG, UK
| | - Erik Persson
- Federal University of Santa Catarina (UFSC), Campus Universitário Reitor João Davi Ferreira Lima, Florianópolis, SC, 88.040-900, Brazil
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2
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Simões E Silva AC, Oliveira EA, Cheung WW, Mak RH. Redox Signaling in Chronic Kidney Disease-Associated Cachexia. Antioxidants (Basel) 2023; 12:antiox12040945. [PMID: 37107320 PMCID: PMC10136196 DOI: 10.3390/antiox12040945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Redox signaling alterations contribute to chronic kidney disease (CKD)-associated cachexia. This review aims to summarize studies about redox pathophysiology in CKD-associated cachexia and muscle wasting and to discuss potential therapeutic approaches based on antioxidant and anti-inflammatory molecules to restore redox homeostasis. Enzymatic and non-enzymatic systems of antioxidant molecules have been studied in experimental models of kidney diseases and patients with CKD. Oxidative stress is increased by several factors present in CKD, including uremic toxins, inflammation, and metabolic and hormone alterations, leading to muscle wasting. Rehabilitative nutritional and physical exercises have shown beneficial effects for CKD-associated cachexia. Anti-inflammatory molecules have also been tested in experimental models of CKD. The importance of oxidative stress has been shown by experimental studies in which antioxidant therapies ameliorated CKD and its associated complications in the 5/6 nephrectomy model. Treatment of CKD-associated cachexia is a challenge and further studies are necessary to investigate potential therapies involving antioxidant therapy.
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Affiliation(s)
- Ana Cristina Simões E Silva
- Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130-100, MG, Brazil
| | - Eduardo A Oliveira
- Department of Pediatrics, Division of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte 30130-100, MG, Brazil
| | - Wai W Cheung
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, La Jolla, CA 92093, USA
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3
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Okamura M, Inoue T, Ogawa M, Shirado K, Shirai N, Yagi T, Momosaki R, Kokura Y. Rehabilitation Nutrition in Patients with Chronic Kidney Disease and Cachexia. Nutrients 2022; 14:nu14224722. [PMID: 36432408 PMCID: PMC9696968 DOI: 10.3390/nu14224722] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Rehabilitation nutrition is a proposed intervention strategy to improve nutritional status and physical function. However, rehabilitation nutrition in patients with cachexia and protein-energy wasting (PEW), which are the main nutrition-related problems in patients with chronic kidney disease (CKD), has not been fully clarified. Therefore, this review aimed to summarize the current evidence and interventions related to rehabilitation nutrition for cachexia and PEW in patients with CKD. CKD is a serious condition worldwide, with a significant impact on patient prognosis. In addition, CKD is easily complicated by nutrition-related problems such as cachexia and PEW owing to disease background- and treatment-related factors, which can further worsen the prognosis. Although nutritional management and exercise therapy are reportedly effective for cachexia and PEW, the effectiveness of combined nutrition and exercise interventions is less clear. In the future, rehabilitation nutrition addressing the nutritional problems associated with CKD will become more widespread as more scientific evidence accumulates. In clinical practice, early intervention in patients with CKD involving both nutrition and exercise after appropriate assessment may be necessary to improve patient outcomes.
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Affiliation(s)
- Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Rehabilitation Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
| | - Tatsuro Inoue
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Masato Ogawa
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe 650-0017, Japan
| | - Kengo Shirado
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Rehabilitation, Aso Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Nobuyuki Shirai
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Rehabilitation, Niigata Rinko Hospital, Niigata 950-8725, Japan
| | - Takuma Yagi
- Change Nutrition from Rehabilitation–Virtual Laboratory (CNR), Niigata 950-3198, Japan
- Department of Rehabilitation, Hattori Hospital, Miki 673-0413, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, Hoso 927-0023, Japan
- Correspondence: ; Tel.: +81-768-52-3335
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4
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Abstract
Individuals with chronic kidney disease (CKD), particularly those undergoing maintenance dialysis, are prone to protein-energy wasting (PEW), the latter of which can be ameliorated with different methods of nutrition support. Dietary counseling guided by dietitians is the key for preventing and managing PEW in CKD. If dietary counseling per se fails to meet the recommended energy and protein requirements, the addition of oral nutrition supplements (ONSs) would be necessary. When these initial measures cannot attain the recommended energy and protein requirements, nutrition support, including enteral tube feeding or parenteral nutrition (PN), should be considered as a viable option to improve nutrition status. Partial PN, comprising intraperitoneal PN (IPPN) and intradialytic PN (IDPN) therapies, may be attempted as supplemental nutrition support in patients with PEW requiring peritoneal dialysis and hemodialysis, respectively. Despite the debatable effectiveness of IPPN for patients undergoing peritoneal dialysis, it remains a feasible means in these patients. The indications for IPPN in patients undergoing peritoneal dialysis include inadequate dietary intake of energy and protein, and barriers of oral intake and other forms of enteral supplementation such as issues with suitability, tolerance, and compliance. Nonetheless, in the case of spontaneous dietary consumption of energy and protein meeting the difference between the IDPN provision and the nutrition targets, the use of IDPN is rational. In patients with PEW and malfunctioning gastrointestinal tract, as well as those whose enteral intake (with or without partial PN) is below the recommended nutrient requirements, total PN becomes a relevant nutrition intervention.
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Affiliation(s)
- Winnie Chan
- School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.,Department of Nephrology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom
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5
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van Egmond S, Hollestein LM, Uyl-de Groot CA, van Erkelens JA, Wakkee M, Nijsten TEC. Practice Variation in Skin Cancer Treatment and Follow-Up Care: A Dutch Claims Database Analysis. Dermatology 2021; 237:1000-1006. [PMID: 33503632 DOI: 10.1159/000513523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quality indicators are used to benchmark and subsequently improve quality of healthcare. However, defining good quality indicators and applying them to high-volume care such as skin cancer is not always feasible. OBJECTIVES To determine whether claims data could be used to benchmark high-volume skin cancer care and to assess clinical practice variation. METHODS All skin cancer care-related claims in dermatology in 2016 were extracted from a nationwide claims database (Vektis) in the Netherlands. RESULTS For over 220,000 patients, a skin cancer diagnosis-related group was reimbursed in 124 healthcare centres. Conventional excision reflected 75% of treatments for skin cancer but showed large variation between practices. Large practice variation was also found for 5-fluorouracil and imiquimod creams. The practice variation of Mohs micrographic surgery and photodynamic therapy was low under the 75th percentile, but outliers at the 100th percentile were detected, which indicates that few centres performed these therapies far more often than average. On average, patients received 1.8 follow-up visits in 2016. CONCLUSIONS Claims data demonstrated large practice variation in treatments and follow-up visits of skin cancer and may be a valid and feasible data set to extract quality indicators. The next step is to investigate whether detected practice variation is unwarranted and if a reduction improves quality and efficiency of care.
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Affiliation(s)
- Sven van Egmond
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands,
| | - Loes M Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | | | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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6
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Will EJ. A short cultural history of the UK Renal Registry 1995-2020. BMC Nephrol 2020; 21:338. [PMID: 32787793 PMCID: PMC7425145 DOI: 10.1186/s12882-020-01997-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022] Open
Abstract
The Renal Association UK Renal Registry (UKRR), established in 1995, has reflected the development of Nephrology within the NHS over 25 years. It has been gradually enlarged to provide a formal agency for a range of consensus initiatives. It remains the source of the national epidemiology of renal replacement, feeding NHS infrastructures and Health Services Research. An extension into acute and chronic kidney disorders is in hand. As a template for medical audit it has contributed to a quality improvement ethos derived from several methodologies. It now offers a multifaceted virtual platform for special interest groups and patient-centricity. Its transformation demonstrates one of the compromises that have permitted specialty development within the inconstant envelope of the NHS. If not always a bellwether, the clarity, form and scale of kidney disease provision still qualifies the UKRR as a demonstrator of healthcare possibilities to Medicine, Clinical Informatics and the NHS.
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Craswell A, Massey D, Wallis M, Sriram D, Gray NA, Kotwal S. Current practice in dialysis central venous catheter management: Multi-disciplinary renal team perspectives. Nephrology (Carlton) 2019; 25:406-412. [PMID: 31260594 DOI: 10.1111/nep.13626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/28/2022]
Abstract
AIM To explore the current practices related to the insertion, management and removal of dialysis central venous catheters (CVCs) used in patients with chronic kidney disease requiring haemodialysis. METHODS This qualitative descriptive study involved semi-structured interviews with surgeons, interventional radiologists, renal physicians, dialysis nurses, renal access nurses and renal researchers involved in the care of patients with chronic kidney disease requiring haemodialysis. Data were collected from staff at eight hospitals in six states and territories of Australia. Thirty-eight face-to-face interviews were conducted. A modified five-step qualitative content analysis approach was used to analyse the data. RESULTS Improved visualization technology and its use by interventional radiologists has steered insertions to specialist teams in specialist locations. This is thought to have decreased risk and improved patient outcomes. Nurses were identified as the professional group responsible for maintaining catheter access integrity, preventing access failure and reducing access-related complications. While best practice was considered important, justifications for variations in practice related to local patient and environment challenges were identified. CONCLUSION The interdisciplinary team is central in the insertion, maintenance, removal and education of patients regarding dialysis CVCs. Clinicians temper research-based decision-making about central dialysis access catheter management with knowledge of individual, environmental and patient factors. Strategies to ensure guidelines are appropriately translated for use in a wide variety of settings are necessary for patient safety.
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Affiliation(s)
- Alison Craswell
- Schoolof Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, Queensland, Australia.,Sunshine Coast Health Institute (SCHI), Birtinya, Queensland, Australia
| | - Debbie Massey
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Marianne Wallis
- Schoolof Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, Queensland, Australia.,Sunshine Coast Health Institute (SCHI), Birtinya, Queensland, Australia
| | - Deepa Sriram
- Schoolof Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, Queensland, Australia.,Sunshine Coast Health Institute (SCHI), Birtinya, Queensland, Australia
| | - Nicholas A Gray
- Renal Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Sunshine Coast Clinical School, University of Queensland, Brisbane, Queensland, Australia
| | - Sradha Kotwal
- Renal and Metabolic Division, The George institute for Global Health, Sydney, New South Wales, Australia
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8
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Niihata K, Shimizu S, Tsujimoto Y, Ikenoue T, Fukuhara S, Fukuma S. Variations and characteristics of quality indicators for maintenance hemodialysis patients: A systematic review. Health Sci Rep 2018; 1:e89. [PMID: 30623044 PMCID: PMC6242363 DOI: 10.1002/hsr2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/20/2018] [Accepted: 08/09/2018] [Indexed: 11/09/2022] Open
Abstract
AIMS Several quality indicators (QIs) to improve the quality of practice for hemodialysis patients have been implemented. However, the variations and characteristics of these indicators in terms of their use and feasibility have not been investigated. We conducted a systematic review to evaluate the variations and characteristics of existing QIs for maintenance hemodialysis patients. METHODS We conducted a systematic literature search of MEDLINE via PubMed, Scopus, the Cochrane Library, and CINAHL, without date limits, on February 26, 2016. We selected the English-written articles regarding QIs for patients aged ≥18 years who were on maintenance hemodialysis therapy ≥3 months, and extracted the definition and development process of the reported QIs. We categorized each indicator into one of four types, namely, structure, process, surrogate outcome, and outcome, and assessed the data sources that were necessary to measure it. RESULTS We included 70 articles and identified 101 indicators, and found that most of the consensus processes for selecting indicators were unclear. We also found that most indicators were not process indicators and that the measurement of some indicators required a chart review, which limits their use and feasibility. CONCLUSIONS Development of QIs for hemodialysis patients in the future should use a definitive consensus process and consider process-centered indicators that can be measured automatically using claims data and test results contained in electronic medical records, to improve usability and feasibility.
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Affiliation(s)
- Kakuya Niihata
- Department of Hygiene and Preventive MedicineSchool of Medicine, Fukushima Medical UniversityFukushimaJapan
- Center for Innovative Research for Communities and Clinical Excellence (CiRCLE)Fukushima Medical UniversityFukushimaJapan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
- Department of Nephrology and Dialysis, Kyoritsu HospitalHyogoJapan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRCLE)Fukushima Medical UniversityFukushimaJapan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Shingo Fukuma
- Center for Innovative Research for Communities and Clinical Excellence (CiRCLE)Fukushima Medical UniversityFukushimaJapan
- Human Health Sciences, Graduate School of MedicineKyoto UniversityKyotoJapan
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9
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McClellan WM, Plantinga LC, Wilk AS, Patzer RE. ESRD Databases, Public Policy, and Quality of Care: Translational Medicine and Nephrology. Clin J Am Soc Nephrol 2017; 12:210-216. [PMID: 27852663 PMCID: PMC5220648 DOI: 10.2215/cjn.02370316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Efforts to improve care of patients with ESRD and the policies that guide those activities depend on evidence-based best practices derived from clinical trials and carefully conducted observational studies. Our review describes this process in the context of the translational research model (bench to bedside to populations), with a particular emphasis on bedside care. We illustrate some of its accomplishments and describe the limitations of the data and evidence supporting policy and practice.
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Affiliation(s)
- William M. McClellan
- Departments of Epidemiology and
- Division of Nephrology, Department of Medicine, and
| | - Laura C. Plantinga
- Departments of Epidemiology and
- Division of Nephrology, Department of Medicine, and
| | - Adam S. Wilk
- Health Policy and Management, Rollins School of Public Health
| | - Rachel E. Patzer
- Departments of Epidemiology and
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Emory University, Atlanta, Georgia
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Nunes JW, Seagull FJ, Rao P, Segal JH, Mani NS, Heung M. Continuous quality improvement in nephrology: a systematic review. BMC Nephrol 2016; 17:190. [PMID: 27881093 PMCID: PMC5121952 DOI: 10.1186/s12882-016-0389-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/03/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Continuous quality improvement (CQI) has been successfully applied in business and engineering for over 60 years. While using CQI techniques within nephrology has received increased attention, little is known about where, and with what measure of success, CQI can be attributed to improving outcomes within nephrology care. This is particularly important as payors' focus on value-based healthcare and reimbursement is tied to achieving quality improvement thresholds. We conducted a systematic review of CQI applications in nephrology. METHODS Studies were identified from PubMed, MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, ProQuest Dissertation Abstracts and sources of grey literature (i.e., available in print/electronic format but not controlled by commercial publishers) between January 1, 2004 and October 13, 2014. We developed a systematic evaluation protocol and pre-defined criteria for review. All citations were reviewed by two reviewers with disagreements resolved by consensus. RESULTS We initially identified 468 publications; 40 were excluded as duplicates or not available/not in English. An additional 352 did not meet criteria for full review due to: 1. Not meeting criteria for inclusion = 196 (e.g., reviews, news articles, editorials) 2. Not nephrology-specific = 153, 3. Only available as abstracts = 3. Of 76 publications meeting criteria for full review, the majority [45 (61%)] focused on ESRD care. 74% explicitly stated use of specific CQI tools in their methods. The highest number of publications in a given year occurred in 2011 with 12 (16%) articles. 89% of studies were found in biomedical and allied health journals and most studies were performed in North America (52%). Only one was randomized and controlled although not blinded. CONCLUSIONS Despite calls for healthcare reform and funding to inspire innovative research, we found few high quality studies either rigorously evaluating the use of CQI in nephrology or reporting best practices. More rigorous research is needed to assess the mechanisms and attributes by which CQI impacts outcomes before there is further promotion of its use for improvement and reimbursement purposes.
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Affiliation(s)
- Julie Wright Nunes
- Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, MI, USA.
| | - F Jacob Seagull
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Panduranga Rao
- Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan H Segal
- Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Nandita S Mani
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Michael Heung
- Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, MI, USA
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Canaud B, Hegbrant J, Nissenson AR, Barth C, Maddux F, Etter M, Krishnan M. Improving outcomes of dialysis patients by population health management-the Global Chief Medical Officer Initiative. Lancet 2016; 388:1966-1967. [PMID: 27789006 DOI: 10.1016/s0140-6736(16)31894-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Bernard Canaud
- Fresenius Medical Care Europe Middle East Africa, 61352 Bad Homburg, Germany.
| | | | | | | | | | - Michael Etter
- Fresenius Medical Care Asia Pacific, Hong Kong, China
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12
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Valentijn PP, Biermann C, Bruijnzeels MA. Value-based integrated (renal) care: setting a development agenda for research and implementation strategies. BMC Health Serv Res 2016; 16:330. [PMID: 27481044 PMCID: PMC4970292 DOI: 10.1186/s12913-016-1586-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/27/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care. METHODS First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles. RESULTS The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak. CONCLUSION These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation model for value-based integrated renal services.
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Affiliation(s)
- Pim P Valentijn
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. .,Department Integrated Care University, Essenburgh, Hierden, The Netherlands.
| | - Claus Biermann
- Faculty of Social Science, Ruhr University Bochum, Bochum, Germany
| | - Marc A Bruijnzeels
- Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Almere, The Netherlands
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13
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Borgert MJ, Goossens A, Dongelmans DA. What are effective strategies for the implementation of care bundles on ICUs: a systematic review. Implement Sci 2015; 10:119. [PMID: 26276569 PMCID: PMC4536788 DOI: 10.1186/s13012-015-0306-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 08/05/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Care bundles have proven to be effective in improving clinical outcomes. It is not known which strategies are the most effective to implement care bundles. A systematic review was conducted to determine the strategies used to implement care bundles in adult intensive care units and to assess the effects of these strategies when implementing bundles. METHODS The databases MEDLINE/PubMed, Ovid/Embase, CINAHL and CENTRAL were searched for eligible studies until January 31, 2015. Studies with (non)randomised designs on central line, ventilator or sepsis bundles were included if implementation strategies and bundle compliance were reported. Methodological quality was assessed by using the Downs and Black checklist. Data extraction and quality assessments were independently performed by two reviewers. RESULTS In total, 1533 records were screened and 47 studies were finally included. In 49 %, pre/post designs were used, 38 % prospective cohorts, and the remaining studies used retrospective designs (6 %), interrupted time series (4 %) and longitudinal designs (2 %). The methodological quality was classified as 'fair' in 77 %, and the remaining as 'good' (13 %) and 'poor' (11 %). The most frequently used strategies were education (86 %), reminders (71 %) and audit and feedback (63 %). Our results show that compliance is influenced by multiple factors, i.e. types and numbers of elements varied and different compliance measurements were reported. Furthermore, compliance was calculated within different time frames. Also, detailed information about compliance, such as numerators and denominators, was not reported. Therefore, recalculation of consistent monthly compliance levels was not possible. CONCLUSIONS The three most frequently used strategies were education, reminders and audit and feedback. We conclude that the heterogeneity among the included studies was high due to the variety in study designs, number and types of elements and types of compliance measurements. Due to the heterogeneity of the data and the poor quality of the studies, conclusions about which strategy results in the highest levels of bundle compliance could not be determined. We strongly recommend that studies in quality improvement should be reported in a formalised way in order to be able to compare research findings. It is imperative that authors follow the standards for quality improvement reporting excellence (SQUIRE) guidelines whenever they report quality improvement studies.
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Affiliation(s)
- Marjon J Borgert
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Astrid Goossens
- Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Dave A Dongelmans
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Silver SA, Thomas A, Rathe A, Robinson P, Wald R, Harel Z, Bell CM. Development of a hemodialysis safety checklist using a structured panel process. Can J Kidney Health Dis 2015; 2:5. [PMID: 25780628 PMCID: PMC4349476 DOI: 10.1186/s40697-015-0039-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The World Health Organization created a Surgical Safety Checklist with a pause or "time out" to help reduce preventable adverse events and improve communication. A similar tool might improve patient safety and reduce treatment-associated morbidity in the hemodialysis unit. OBJECTIVE To develop a Hemodialysis Safety Checklist (Hemo Pause) for daily use by nurses and patients. DESIGN A modified Delphi consensus technique based on the RAND method was used to evaluate and revise the checklist. SETTING University-affiliated in-center hemodialysis unit. PARTICIPANTS A multidisciplinary team of physicians, nurses, and administrators developed the initial version of the Hemo Pause Checklist. The evaluation team consisted of 20 registered hemodialysis nurses. MEASUREMENTS The top 5 hemodialysis safety measures according to hemodialysis nurses. A 75% agreement threshold was required for consensus. METHODS The structured panel process was iterative, consisting of a literature review to identify safety parameters, individual rating of each parameter by the panel of hemodialysis nurses, an in-person consensus meeting wherein the panel refined the parameters, and a final anonymous survey that assessed panel consensus. RESULTS The literature review produced 31 patient safety parameters. Individual review by panelists reduced the list to 25 parameters, followed by further reduction to 19 at the in-person consensus meeting. The final round of scoring yielded the following top 5 safety measures: 1) confirmation of patient identity, 2) measurement of pre-dialysis weight, 3) recognition and transcription of new medical orders, 4) confirmation of dialysate composition based on prescription, and 5) measurement of pre-dialysis blood pressure. Revision using human factors principles incorporated the 19 patient safety parameters with greater than or equal to 75% consensus into a final checklist of 17-items. LIMITATIONS The literature review was not systematic. This was a single-center study, and the panel lacked patient and family representation. CONCLUSIONS A novel 17-item Hemodialysis Safety Checklist (Hemo Pause) for use by nurses and patients has been developed to standardize the hemodialysis procedure. Further quality improvement efforts are underway to explore the feasibility of using this checklist to reduce adverse events and strengthen the safety culture in the hemodialysis unit.
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Affiliation(s)
- Samuel A Silver
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Alison Thomas
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Andrea Rathe
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Pamela Robinson
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ron Wald
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ziv Harel
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Chaim M Bell
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- />Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Blumenthal KG, Shenoy ES, Hurwitz S, Varughese CA, Hooper DC, Banerji A. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:407-13. [PMID: 25017528 DOI: 10.1016/j.jaip.2014.02.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/07/2014] [Accepted: 02/05/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. OBJECTIVES Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. METHODS We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. RESULTS Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P < .001) and loss of PCN allergy over time (54% vs 80%; P < .0001). Among those who reported attending an educational session (n = 62), preparedness to determine if an allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. CONCLUSIONS Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools.
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Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass.
| | - Erica S Shenoy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass; Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Infection Control Unit, Massachusetts General Hospital, Boston, Mass
| | - Shelley Hurwitz
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Christy A Varughese
- Infection Control Unit, Massachusetts General Hospital, Boston, Mass; Department of Pharmacy, Massachusetts General Hospital, Boston, Mass
| | - David C Hooper
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Infection Control Unit, Massachusetts General Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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16
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Barriers to Adopting a Fistula-First Policy in Europe: An International Survey among National Experts. J Vasc Access 2014; 16:113-9. [DOI: 10.5301/jva.5000313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to explore how vascular access care was reimbursed, promoted, and organised at the national level in European and neighbouring countries. Methods An electronic survey among national experts to collect country-level data. Results Forty-seven experts (response rate, 76%) from 37 countries participated. Experts from 23 countries reported that 50% or less of patients received routine pre-operative imaging of vessels. Nephrologists placed catheters and created fistulas in 26 and 8 countries, respectively. Twenty-one countries had a fee per created access; the reported fee for catheter placement was never higher than for fistula creation. As the number of haemodialysis patients in a centre increased, more countries had a dedicated coordinator or multidisciplinary team responsible for vascular access maintenance at the centre-level; in 11 countries, responsibility was always with individual nephrologists, independent of a centre's size. In 23 countries, dialysis centres shared vascular access care resources, with facilitation from a service provider in 4. In most countries, national campaigns (n = 35) or educational programmes (n = 29) had addressed vascular access-related topics; 19 countries had some form of training for creating fistulas. Forty experts considered the current evidence base robust enough to justify a fistula-first policy, but only 13 believed that more than 80% of nephrologists in their country would attempt a fistula in a 75-year-old woman with comorbidities. Conclusions Suboptimal access to surgical resources, lack of dedicated training of clinicians, limited routine use of pre-operative diagnostic imaging and patient characteristics primarily emerged as potential barriers to adopting a fistula-first policy in Europe.
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van der Veer SN, Tomson CRV, Jager KJ, van Biesen W. Bridging the gap between what is known and what we do in renal medicine: improving implementability of the European Renal Best Practice guidelines. Nephrol Dial Transplant 2013; 29:951-7. [DOI: 10.1093/ndt/gft496] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van der Veer SN, van Biesen W, Couchoud C, Tomson CRV, Jager KJ. Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators. Nephrol Dial Transplant 2013; 29:1460-7. [PMID: 24286978 DOI: 10.1093/ndt/gft473] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surrogate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some pointers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indicator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain-i.e. subsequent aspects of care connected by evidence-based links-as a starting point for composing a performance indicator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facilities over time.
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Affiliation(s)
- Sabine N van der Veer
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands European Renal Best Practice (ERBP) Methods Support Team, University Hospital Ghent, Ghent, Belgium
| | - Wim van Biesen
- European Renal Best Practice (ERBP) Methods Support Team, University Hospital Ghent, Ghent, Belgium Renal division, University Hospital Ghent, Ghent, Belgium
| | - Cécile Couchoud
- REIN Registry, Agence de la biomédecine, Saint Denis la Plaine Cedex, France
| | | | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands ERA-EDTA Registry, Academic Medical Center, Amsterdam, The Netherlands
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20
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Production scientifique du REIN. Nephrol Ther 2013; 9 Suppl 1:S193-7. [DOI: 10.1016/s1769-7255(13)70046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Pippias M, Tomson CRV. Patient safety in chronic kidney disease: time for nephrologists to take action. Nephrol Dial Transplant 2013; 29:473-5. [PMID: 23975749 DOI: 10.1093/ndt/gft364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maria Pippias
- Specialist Registrar in Nephrology, Richard Bright Renal Unit, Southmead Hospital, Bristol BS10 5NB, UK
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22
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Couchoud C, Lassalle M, Cornet R, Jager KJ. Renal replacement therapy registries--time for a structured data quality evaluation programme. Nephrol Dial Transplant 2013; 28:2215-20. [PMID: 23386707 DOI: 10.1093/ndt/gft004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Registries in the area of renal replacement therapy (RRT) are intended to be a tool for epidemiological research, health care planning and improvement of quality of care. In this perspective, the value of a population-based RRT registry and its ability to achieve its goals rely heavily on the quality of its data and on quality control procedures. Data quality is of crucial importance to prevent 'garbage coming out from garbage going in'. Regular evaluations of the data quality within these registries are needed to assess various aspects of data quality like completeness, prevention of duplicates, data validity, comparability, timeliness, usefulness and responsiveness of different items and accuracy of reporting and interpretation. In this technical note, we will discuss the purposes of RRT registries and the importance of different aspects of data quality in relation to those purposes. In addition, we discuss how these data quality aspects can be assessed and, where possible, how data quality may be improved.
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Affiliation(s)
- Cécile Couchoud
- REIN Registry, Agence de la biomedicine, Saint-Denis La Plaine, France
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Abstract
Modern medicine is complex and delivered by interdependent teams. Conscious redesign of the way in which these teams interact can contribute to improving the quality of care by reducing practice variation. This requires techniques that are different to those used for individual patient care. In this paper, we describe some of these quality improvement (QI) techniques. The first section deals with the identification of practice variation as the starting point of a systematic QI endeavour. This involves collecting data in multiple centres on a set of quality indicators as well as on case-mix variables that are thought to affect those indicators. Reporting the collected indicator data in longitudinal run charts supports teams in monitoring the effect of their QI effort. After identifying the opportunities for improvement, the second section discusses how to reduce practice variation. This includes selecting the 'package' of clinical actions to implement, identifying subsidiary actions to achieve the improvement aim, designing the implementation strategy and ways to incentivise QI.
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Affiliation(s)
- Charles R V Tomson
- Department of Renal Medicine, Southmead Hospital, Westbury-on-Trym, Bristol.
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