Utility of the advanced chronic kidney disease patient management tools: Case studies

作者：Patwardhan Meenal B^*; Matchar David B; Samsa Gregory P; Haley William E

来源：American Journal of Medical Quality, 2008, 23(2): 105-114.

DOI：10.1177/1062860607313142

• chronic kidney disease
• guideline implementation
• implementation tools
• quality improvement

Appropriate management of advanced chronic kidney disease (CKD) delays or limits its progression. The Advanced CKD Patient Management Toolkit was developed using a process-improvement technique to assist patient management and address CKD-specific management issues. We pilot tested the toolkit in 2 community nephrology practices, assessed the utility of individual tools, and evaluated the impact on conformance to an advanced CKD guideline through patient chart abstraction. Tool use was distinct in the 2 sites and depended on the site champion's involvement, the extent of process reconfiguration demanded by a tool, and its perceived value. Baseline conformance varied across guideline recommendations (averaged 54%). Posttrial conformance increased in all clinical areas (averaged 59%). Valuable features of the toolkit in real-world settings were its ability to: facilitate tool selection, direct implementation efforts in response to a baseline performance audit, and allow selection of tool versions and customizing them. Our results suggest that systematically created, multifaceted, and customizable tools can promote guideline conformance.

• 出版日期2008-4