Quality improvement at scale: evaluation of the drivers and barriers to adoption and sustainability of an intervention to reduce late referral in chronic kidney disease

Journal article


Thomas, N., Woolnough, L., Nation, M. and Gallagher, H. (2020). Quality improvement at scale: evaluation of the drivers and barriers to adoption and sustainability of an intervention to reduce late referral in chronic kidney disease. BMJ Open Quality. 9, p. e001045. https://doi.org/10.1136/bmjoq-2020-001045
AuthorsThomas, N., Woolnough, L., Nation, M. and Gallagher, H.
Abstract

This quality improvement project aimed to drive large-scale and sustained change to reduce the burden of chronic kidney disease in the UK. The intervention is a software programme that extracts relevant biochemical data from laboratory databases which then generate graphs of estimated kidney function (eGFR) over time. Graphs showing progressive kidney disease are sent directly back to GPs to alert them to re-review patient care and if necessary, refer to renal services. The aim of this evaluation study was to explain the barriers and drivers to implementation and adoption of the eGFR graph intervention.

This evaluation study involved five of the 20 renal units (sites) involved. A Developmental Evaluation approach was utilised. Methods included collection of descriptive data about graph reporting; GP surveys (n=68); focus groups (n=4) with Practices; face-to-face interviews with secondary care clinicians (n=10).

Results showed the mean number of graphs reviewed per week per site was 230, taking one hour per week per site. Only 18.2 % graphs highlighted a concerning decline in kidney function. Important enablers to sustain the intervention were low cost, easy to understand, a sense of local ownership and perceived impact. Barriers included nephrologists’ perceived increase in new referrals.

We concluded that developmental evaluation can explain the barriers/drivers to implementation of a national quality improvement project that involves a variety of different stakeholders. The intervention has the potential to slow down progression of kidney disease due to the eGFR prompts alerting GPs to review the patient record and take action, such as reviewing medications and referring to renal teams if progressive kidney disease had not been identified previously.

Keywordschronic disease management; primary care; quality improvement; evaluation methodology
Year2020
JournalBMJ Open Quality
Journal citation9, p. e001045
PublisherBMJ Publishing Group
ISSN2399-6641
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjoq-2020-001045
Publication dates
Online12 Nov 2020
Publication process dates
Accepted26 Oct 2020
Deposited27 Oct 2020
Accepted author manuscript
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Controlled
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Open
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