1 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 QUALITY IMPROVEMENT IN PRIMARY CARE A Care bundle approach Slide Set 2 (rev Sept2014)
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1 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough.
3 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No Registered Charity No Registered Scottish Charity No. SC Have evidence-based guidance (NICE 2014) for managing CKD in primary care but evidence of inconsistency of care -Variation in prevalence recording (www.ic.nhs.uk) -Difficulties with proteinuria measurement -Blood pressure QoF vs NICE targets Variability of care Rationale: variability in care Slide Set 2 (rev Sept2014)
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1Project supported by
A Package of Innovation forManaging kidney disease in primary care
Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ.
Kidney Research UK is a limited company registered in England. Registered Company No. 905963
Use a care bundle approach“A care bundle is a grouping of several evidence-based elements carried out at the same time, that have the potential to significantly improve patient care outcomes”
- Use evidence based guidelines- Include patients in design of the approach - Reduce inconsistency – aim to achieve 95% reliability
Develop innovative ways to improve consistency
Slide Set 2 (rev Sept2014)
6Project supported by
A Package of Innovation forManaging kidney disease in primary care
Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ.
Kidney Research UK is a limited company registered in England. Registered Company No. 905963
Anticipated impactAim to achieve 95% compliance with bundle - only if all components are applied at the same timeSecondary outcomes:- Accurate CKD register- Improved proteinuria testing- Improved BP control- Reduced cardio-vascular risk
Slide Set 2 (rev Sept2014)
7Project supported by
A Package of Innovation forManaging kidney disease in primary care
Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ.
Kidney Research UK is a limited company registered in England. Registered Company No. 905963
Problem: not achieving high rates of proteinuria measurementRequested urine test (ACR) = early morning urineAfter discussion urine test = spot urine (any time of day)Led to increased reliability
Example of test of change
Slide Set 2 (rev Sept2014)
16Project supported by
A Package of Innovation forManaging kidney disease in primary care
Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ.
Kidney Research UK is a limited company registered in England. Registered Company No. 905963
Date of data collection (2011/12) Nov Dec Jan Feb MarObserved prevalence of Stage 3 to 5 CKD 5% 5% 5% 6% 6%Percentage with proteinuria test in previous 15/12 67% 70% 68% 73% 79%BP <140mmHg (no diabetes) 38% 54% 70% 63% 64%BP <130mmHg (with diabetes) 12% 29% 39% 42% 40%
Practice in North Wales (Wrexham) 4294 registered patients
Case study 2:Improvements in clinical care
Slide Set 2 (rev Sept2014)
17Project supported by
A Package of Innovation forManaging kidney disease in primary care
Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ.
Kidney Research UK is a limited company registered in England. Registered Company No. 905963
Feedback on self-management materials"I've been to the surgery more this year because of this (CKD) than the rest of
the time put together.""I was able to look at the DVD, jot down questions and then get answers - you forget everything because it is such a
shock.""She (the practice nurse)
has given me the confidence.... and I do feel
better now and I have every faith in my nurse."
“A positive way in which to improve my
health...(the Booklet)."
"I have lost one stone since January, if I had not known about this (CKD), I would not have done it."
“The Booklet was very helpful, I read it quite
often."
"The DVD was quite helpful , describing the different stages that people had. I did not want to go any lower than that (eGFR) as I did not want to go on tablets - it was a kick
start to helping myself."
Slide Set 2 (rev Sept2014)
18Project supported by
A Package of Innovation forManaging kidney disease in primary care
Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ.
Kidney Research UK is a limited company registered in England. Registered Company No. 905963
•A significant number of Practices have continued to use the care bundle approach now the project has ended, having found that despite initial concerns, it could be applied within normal consultation time once they were used to the process•All Practices said they were now more aware of CKD and its management, including:
–Finding more patients with CKD–Monitoring eGFR and blood pressure–Informing more patients of their diagnosis of CKD
•All practitioners felt the resources for patients were very useful and added to their knowledge and understanding, as well as helping them to self-manage •Practice staff reported that patients were more informed, more involved and grateful for the opportunity