Informatics as Tool for Quality Improvement: Rapid Implementation of Guidance for the Management of Chronic Kidney Disease in England as an Exemplar.
- Author:
Simon DE LUSIGNAN
1
Author Information
- Publication Type:Review
- Keywords: Medical Informatics; Renal Insufficiency; Diabetes Mellitus; Computerized Medical Records Systems; Kidney Function Tests; Health Policy; Quality of Health Care
- MeSH: Blood Pressure; Clinical Coding; Creatinine; Diabetes Mellitus; Dietary Sucrose; England; General Practice; Health Policy; Humans; Informatics; Kidney Failure, Chronic; Kidney Function Tests; Medical Informatics; Medical Records; Medical Records Systems, Computerized; National Health Programs; Primary Health Care; Quality Improvement; Quality of Health Care; Renal Insufficiency; Renal Insufficiency, Chronic
- From:Healthcare Informatics Research 2013;19(1):9-15
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVES: Chronic kidney disease (CKD) is an important cause of excess cardiovascular mortality and morbidity; as well as being associated with progression to end stage renal disease. This condition was largely unheard of in English primary care prior to the introduction of pay-for-performance targets for management in 2006. A realist review of how informatics has been a mechanism for national implementation of guidance for the improved management of CKD. METHODS: Realist review of context, the English National Health Service with a drive to implement explicit national quality standards; mechanism, the informatics infrastructure and its alignment with policy objectives; and outcomes are describe at the micro-data and messaging, meso-patient care and quality improvement initiatives, and marco-national policy levels. RESULTS: At the micro-level computerised medical records can be used to reliably identify people with CKD; though differences in creatinine assays, fluctuation in renal function, and errors in diabetes coding were less well understood. At the meso-level more aggressive management of blood pressure (BP) in individual patients appears to slow or reverse decline in renal function; technology can support case finding and quality improvement at the general practice level. At the macro-level informaticians can help ensure that leverage from informatics is incorporated in policy, and ecological investigations inform if there is any association with improved health outcomes. CONCLUSIONS: In the right policy context informatics appears to be an enabler of rapid quality improvement. However, a causal relationship or generalisability of these findings has not been demonstrated.
