Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative

Int J Qual Health Care. 2015 Feb;27(1):10-6. doi: 10.1093/intqhc/mzu097. Epub 2014 Dec 18.


Quality problem: Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD.

Initial assessment: Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼ 30% were estimated to have suboptimal management according to Public Health Observatory analyses.

Choice of solution: An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices.

Implementation: A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement.

Evaluation: Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼ 2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved.

Lessons learned: An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention.

Keywords: chronic kidney disease; evidence-based guidance; implementation; improvement collaborative; primary care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benchmarking
  • Blood Pressure
  • Disease Management*
  • Guideline Adherence
  • Humans
  • Insurance, Health, Reimbursement
  • Practice Guidelines as Topic
  • Prevalence
  • Primary Health Care / organization & administration*
  • Program Evaluation
  • Quality Improvement / organization & administration*
  • Renal Insufficiency, Chronic / therapy*