Identifying the 'missing thousands' of people with undiagnosed chronic kidney disease in Greater Manchester
Improving chronic kidney disease (CKD) care project supports GP practices to improve identification and management of people with early stage CKD.
UPDATED JULY 2015
The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester improving chronic kidney disease (CKD) care project supported GP practices to improve their identification and management of people with early stage CKD. It was identified that there were fewer people in Greater Manchester diagnosed with CKD than the expected prevalence suggested there would be, meaning that people who have CKD may not have been be getting the best care and treatment. End stage CKD is growing at 6% per annum and poses a huge financial cost for the NHS: diagnosing and treating this disease effectively as early as possible is hugely important.
Phase one of the project identified 1,324 additional patients with CKD across 19 GP surgeries and increased the number of CKD patients being treated to recommended blood pressure targets from 34% to 74%. Phase two of the project identified 539 additional patients with CKD across 11 GP surgeries and 83% of them were treated to recommended blood pressure targets.
- In total, 2,729 additional patients with CKD were identified across 61 GP surgeries in Greater Manchestr
- 77% of people diagnosed with CKD had been tested for proteinuria and had their blood pressure controlled to NICE recommended targets after the intervention projects.
- A CKD audit tool was imported to support the implementation of the second CKD project within the programme. A collaboration followed with the original designers to produce a comprehensive CKD improvement support website. IMproving Patient care and Awareness of Kidney disease Together (IMPAKTâ„¢) hosts the audit tool with a range of supporting resources (e.g. IMPAKTâ„¢ improvement guide), enabling practices nationwide to make improvements to their CKD registers both within and outside of CLAHRC GM facilitated projects
The CLAHRC GM team have developed a methodology for getting research into practice so that patients benefit from best practice and evidence-based care. The approach involves the mobilisation of knowledge from research in parallel with local active support programmes to introduce and embed change.
The research builds on three areas of expertise in:
- The ‘Promoting Action on Research Implementation in Health Services’ (PARIHS) framework which identifies the factors that influence the successful implementation of research evidence into practice
- Quality improvement models in healthcare
- Knowledge Transfer Partnerships to drive change through incremental, small-scale improvements
Findings and lessons from our implementation approach have been published in various forums, including peer-reviewed journals and a book on implementing evidence-based change in healthcare settings.
- Humphreys J., Harvey, G. et al. “Quality Improvement Report: A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester”. BMJ Qual Saf 2012;21:700-708 doi:10.1136/bmjqs-2011-000664
- Blakeman, T., Harding, S., O’Donoghue, D. “Acute kidney injury in the community: why primary care has an important role”. doi:10.3399/bjgp13X664207BJGP April 1, 2013 vol. 63no. 609 173-174
- Kitson A. et al. (2008) “Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges” Implementation Science doi:10.1186/1748-5908-3-1
- Seers K. et al. (2012) “FIRE (Facilitating Implementation of Research Evidence): a study protocol” Implementation Science doi: 10.1186/1748-5908-7-25
- Boaden R. et al. (2008). Quality Improvement: theory and practice in healthcare. NHS Institute for Innovation and Improvement/Alliance Manchester Business School, Coventry: NHS Institute for Innovation and Improvement
- Harvey G. et al. (2011) “The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester: Combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy” Implementation Science 6(1) doi:10.1186/1748-5908-6-96
Professor Ruth Boaden
Dr Gillian Harvey
Dr Susan Howard (CLAHRC Greater Manchester)
Mr John Humphreys (CLAHRC Greater Manchester)