A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy
Abstract Background Patients who start renal replacement therapy (RRT) for End-Stage Kidney Disease (ESKD) without having had timely access to specialist renal services have poor outcomes. At one NHS Trust in England, a community-wide CKD management system has led to a decline in the incident rate o...
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-017-0522-9 |
| _version_ | 1818995133598662656 |
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| author | Hugh Gallagher Shona Methven Anna Casula Nicola Thomas Charles R. V. Tomson Fergus J. Caskey Tracey Rose Stephen J. Walters David Kennedy Anne Dawnay Martin Cassidy Richard Fluck Hugh C. Rayner Michael Nation |
| author_facet | Hugh Gallagher Shona Methven Anna Casula Nicola Thomas Charles R. V. Tomson Fergus J. Caskey Tracey Rose Stephen J. Walters David Kennedy Anne Dawnay Martin Cassidy Richard Fluck Hugh C. Rayner Michael Nation |
| author_sort | Hugh Gallagher |
| collection | DOAJ |
| description | Abstract Background Patients who start renal replacement therapy (RRT) for End-Stage Kidney Disease (ESKD) without having had timely access to specialist renal services have poor outcomes. At one NHS Trust in England, a community-wide CKD management system has led to a decline in the incident rate of RRT and the lowest percentage of patients presenting within 90 days of starting RRT in the UK. We describe the protocol for a quality improvement project to scale up and evaluate this innovation. Methods The intervention is based upon an off-line database that integrates laboratory results from blood samples taken in all settings stored under different identifying labels relating to the same patient. Graphs of estimated glomerular filtration rate (eGFR) over time are generated for patients <65 years with an incoming eGFR <50 ml/min/1.73 m2 and patients >65 years with an incoming eGFR <40 ml/min/1.73 m2. Graphs where kidney function is deteriorating are flagged by a laboratory scientist and details sent to the primary care doctor (GP) with a prompt that further action may be needed. We will evaluate the impact of implementing this intervention across a large population served by a number of UK renal centres using a mixed methods approach. We are following a stepped-wedge design. The order of implementation among participating centres will be randomly allocated. Implementation will proceed with unidirectional steps from control group to intervention group until all centres are generating graphs of eGFR over time. The primary outcome for the quantitative evaluation is the proportion of patients referred to specialist renal services within 90 days of commencing RRT, using data collected routinely by the UK Renal Registry. The qualitative evaluation will investigate facilitators and barriers to adoption and spread of the intervention. It will include: semi-structured interviews with laboratory staff, renal centre staff and service commissioners; an online survey of GPs receiving the intervention; and focus groups of primary care staff. Discussion Late presentation to nephrology for patients with ESKD is a source of potentially avoidable harm. This protocol describes a robust quantitative and qualitative evaluation of a quality improvement intervention to reduce late presentation and improve the outcomes for patients with ESKD. |
| first_indexed | 2024-12-20T21:09:00Z |
| format | Article |
| id | doaj.art-640a0f19e34748dfa274bf45962c02c0 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-20T21:09:00Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-640a0f19e34748dfa274bf45962c02c02022-12-21T19:26:33ZengBMCBMC Nephrology1471-23692017-04-0118111010.1186/s12882-017-0522-9A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapyHugh Gallagher0Shona Methven1Anna Casula2Nicola Thomas3Charles R. V. Tomson4Fergus J. Caskey5Tracey Rose6Stephen J. Walters7David Kennedy8Anne Dawnay9Martin Cassidy10Richard Fluck11Hugh C. Rayner12Michael Nation13South West Thames Renal Unit, Epsom and St Helier NHS TrustUK Renal RegistryUK Renal RegistrySchool of Health and Social Care, London South Bank UniversityRenal Services Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS TrustUK Renal RegistryPPI Representative for UK Kidney Research Consortium and National Institute for Healthcare ResearchSchool of Health and Related Research, University of SheffieldSouth of Tyne and Wear Clinical Pathology Services, Gateshead Health NHS Foundation TrustClinical Biochemistry, University College London HospitalsQuality Improvement, East Midlands Clinical Networks & SenateDepartment of Renal Medicine, Royal Derby HospitalHeart of England NHS Foundation TrustKidney Research UKAbstract Background Patients who start renal replacement therapy (RRT) for End-Stage Kidney Disease (ESKD) without having had timely access to specialist renal services have poor outcomes. At one NHS Trust in England, a community-wide CKD management system has led to a decline in the incident rate of RRT and the lowest percentage of patients presenting within 90 days of starting RRT in the UK. We describe the protocol for a quality improvement project to scale up and evaluate this innovation. Methods The intervention is based upon an off-line database that integrates laboratory results from blood samples taken in all settings stored under different identifying labels relating to the same patient. Graphs of estimated glomerular filtration rate (eGFR) over time are generated for patients <65 years with an incoming eGFR <50 ml/min/1.73 m2 and patients >65 years with an incoming eGFR <40 ml/min/1.73 m2. Graphs where kidney function is deteriorating are flagged by a laboratory scientist and details sent to the primary care doctor (GP) with a prompt that further action may be needed. We will evaluate the impact of implementing this intervention across a large population served by a number of UK renal centres using a mixed methods approach. We are following a stepped-wedge design. The order of implementation among participating centres will be randomly allocated. Implementation will proceed with unidirectional steps from control group to intervention group until all centres are generating graphs of eGFR over time. The primary outcome for the quantitative evaluation is the proportion of patients referred to specialist renal services within 90 days of commencing RRT, using data collected routinely by the UK Renal Registry. The qualitative evaluation will investigate facilitators and barriers to adoption and spread of the intervention. It will include: semi-structured interviews with laboratory staff, renal centre staff and service commissioners; an online survey of GPs receiving the intervention; and focus groups of primary care staff. Discussion Late presentation to nephrology for patients with ESKD is a source of potentially avoidable harm. This protocol describes a robust quantitative and qualitative evaluation of a quality improvement intervention to reduce late presentation and improve the outcomes for patients with ESKD.http://link.springer.com/article/10.1186/s12882-017-0522-9Chronic kidney diseaseRenal replacement therapyQuality improvementEvaluation studies |
| spellingShingle | Hugh Gallagher Shona Methven Anna Casula Nicola Thomas Charles R. V. Tomson Fergus J. Caskey Tracey Rose Stephen J. Walters David Kennedy Anne Dawnay Martin Cassidy Richard Fluck Hugh C. Rayner Michael Nation A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy BMC Nephrology Chronic kidney disease Renal replacement therapy Quality improvement Evaluation studies |
| title | A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy |
| title_full | A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy |
| title_fullStr | A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy |
| title_full_unstemmed | A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy |
| title_short | A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy |
| title_sort | programme to spread egfr graph surveillance for the early identification support and treatment of people with progressive chronic kidney disease assist ckd protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy |
| topic | Chronic kidney disease Renal replacement therapy Quality improvement Evaluation studies |
| url | http://link.springer.com/article/10.1186/s12882-017-0522-9 |
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