Closing the gap between evidence and practice in chronic kidney disease

Jardine, Meg; Kasiske, Bertram L.; Adu, Dwomoa; Alrukhaimi, Mona; Ashuntantang, Gloria; Basnet, Shakti; Chailimpamontree, Worawon; Craig, Jonathan C.; O’Donoghue, Dónal; Perkovic, Vlado; Powe, Neil R.; Roberts, Charlotte; Suzuki, Yusuke; Tanaka, Tetsuhiro; Uhlig, Katrin

doi:10.1016/j.kisu.2017.07.006

Cited by 16 publications

(19 citation statements)

References 34 publications

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“…As a ubiquitous condition defined by objective laboratory criteria and having evidence‐based guidelines for treatment, CKD is a model use case for understanding the foundational data standards for population health management in learning health systems. Despite financial incentives that increasingly reward coordinated care, pervasive deficiencies in CKD treatment continue . For any condition, complete, well‐specified standards will be needed to define the patient population, to codify the health services delivered, and to evaluate patient‐centered outcomes.…”

Section: Discussionmentioning

confidence: 99%

Data and knowledge standards for learning health: A population management example using chronic kidney disease

Cameron

Douthit

Richesson

2018

Learning Health Systems

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The widespread creation of learning health care systems (LHSs) will depend upon the use of standards for data and knowledge representation. Standards can facilitate the reuse of approaches for the identification of patient cohorts and the implementation of interventions. Standards also support rapid evaluation and dissemination across organizations. Building upon widely-used models for process improvement, we identify specific LHS activities that will require data and knowledge standards. Using chronic kidney disease (CKD) as an example, we highlight the specific data and knowledge requirements for a disease-specific LHS cycle, and subsequently identify areas where standards specifications, clarification, and tools are needed. The current data standards for CKD population management recommendations were found to be partially ambiguous, leading to barriers in phenotyping, risk identification, patient-centered clinical decision support, patient education needs, and care planning.Robust tools are needed to effectively identify patient health care needs and preferences and to measure outcomes that accurately depict the multiple facets of CKD. This example presents an approach for defining the specific data and knowledge representation standards required to implement condition-specific population health management programs. These standards specifications can be promoted by disease advocacy and professional societies to enable the widespread design, implementation, and evaluation of evidence-based health interventions, and the subsequent dissemination of experience in different settings and populations. arising from overwhelming system complexity, suboptimal data quality and analytical tools, and misaligned health care policies. [2][3][4][5][6] In particular, health care organizations struggle to leverage data stored within proprietary electronic health record (EHR) systems to gainThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. In this paper, we use existing models for evidence-based medicine (EBM), learning health, and process improvement to identify datadependent activities, which by definition will benefit from the use of standards. We identify relevant data domains for each datadependent activity, and look at national standards to evaluate the clarity and specificity of those current data standards in the context of a population management program for CKD. | DATA-DEPENDENT ACTIVITIES AND STANDARDS FOR LEARNING HEALTH SYSTEMSIn an early roundtable on learning health, the Institute of Medicine set a goal that "by the year 2020, ninety percent of clinical decisions will be supported by accurate, timely, and up-to-date information, and will reflect the best available evidence. The data-dependent LHS activities (design, implement, evaluate, and adjust) are presented above with a n...

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Section: Discussionmentioning

confidence: 99%

Data and knowledge standards for learning health: A population management example using chronic kidney disease

Cameron

Douthit

Richesson

2018

Learning Health Systems

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“… 23 Despite the establishment and promotion of facilitated relay and other quality improvement strategies, there remain significant treatment gaps in hypertension 24 and other chronic conditions. 25 Furthermore, while facilitated relay has been shown to be effective in improving a number of cardiovascular risk factors, 21 26 it remains among the least commonly used quality improvement strategies 27 and has not been explored in the management of dyslipidaemia.…”

Section: Introductionmentioning

confidence: 99%

Strategies for enhancing the initiation of cholesterol lowering medication among patients at high cardiovascular disease risk: a qualitative descriptive exploration of patient and general practitioners’ perspectives on a facilitated relay intervention in Alberta, Canada

et al. 2020

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ObjectiveThe objective of our study was to explore the perspectives of patients and general practitioners (GPs) regarding interventions to increase initiation of cholesterol lowering medication (or statins), including a proposed laboratory-based facilitated relay intervention.DesignQualitative descriptive study using interviews and focus groups for data collection, and thematic analysis for data analysis.SettingPrimary care providers and patients in Calgary, Alberta, Canada.Participants17 GPs with primarily community-based, non-academic practices with at least 1 year of practice experience participated in semistructured interviews. 14 patients at high risk of cardiovascular disease participated in focus groups.Main outcome measuresExploration of strategies that might be used to enhance the prescription of, and adherence to statin therapy for patients with statin-indicated conditions.ResultsGPs proposed a variety of interventions to improve statin prescription, including electronic record audit solutions, GP directed education, and patient-oriented campaigns. Patients expressed that they may benefit from being provided access to their laboratory test results, as well as targeted education. Both parties provided positive feedback on the proposed laboratory-based facilitated relay intervention, while pointing out areas for improvement. Notably, GPs were concerned that the patient-directed component of the intervention might jeopardise therapeutic relationships, and patients were concerned about accidental disclosure of personal health information. Important considerations for the design of facilitated relay messaging should include brevity, simplicity and the provision of contact information for inquiries.ConclusionsGPs and patients described several suggestions for increasing statin initiation and welcomed the proposal of a laboratory-based facilitated relay strategy. These findings support further testing of this intervention which may enhance GPs’ ability to successfully engage patients in cardiovascular risk reduction through statin therapy.

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“…There is often a gap or lag between the growing knowledge of efficacious evidence-based interventions and public health practice. [1][2][3] Implementation science closes this gap by examining the process of how new research findings or interventions are translated into routine practice (implementation) and how contextual and other factors affect implementation. 2 4 Effective implementation of interventions is vital for achieving the intended outcomes.…”

Section: Introductionmentioning

confidence: 99%

Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study

et al. 2020

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ObjectiveTo assess whether organisational culture influences the fidelity of implementation of the Integrated Chronic Disease Management (ICDM) model at primary healthcare (PHC) clinics.DesignA cross-sectional study.SettingThe ICDM model was introduced in South African clinics to strengthen delivery of care and improve clinical outcomes for patients with chronic conditions, but the determinants of its implementation have not been assessed.ParticipantsThe abbreviated Denison organisational culture (DOC) survey tool was administered to 90 staff members to assess three cultural traits: involvement, consistency and adaptability of six PHC clinics in Dr. Kenneth Kaunda and West Rand (WR) health districts.Primary and secondary outcome measuresEach cultural trait has three indices with five items, giving a total of 45 items. The items were scored on a Likert scale ranging from one (strongly disagree) to five (strongly agree), and mean scores were calculated for each item, cultural traits and indices. Descriptive statistics were used to describe participants and clinics, and Pearson correlation coefficient to asses association between fidelity and culture.ResultsParticipants’ mean age was 38.8 (SD=10.35) years, and 54.4% (49/90) were nurses. The overall mean score for the DOC was 3.63 (SD=0.58). The involvement (team orientation, empowerment and capability development) cultural trait had the highest (3.71; SD=0.72) mean score, followed by adaptability (external focus) (3.62; SD=0.56) and consistency (3.56; SD=0.63). There were no statistically significant differences in cultural scores between PHC clinics. However, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p=0.011; adaptability 3.40 vs 3.73, p=0.007; consistency 3.34 vs 3.68, p=0.034).ConclusionLeadership intervention is required to purposefully enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model’s principles of coordinated, integrated, patient-centred care.

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Closing the gap between evidence and practice in chronic kidney disease

Cited by 16 publications

References 34 publications

Data and knowledge standards for learning health: A population management example using chronic kidney disease

Data and knowledge standards for learning health: A population management example using chronic kidney disease

Strategies for enhancing the initiation of cholesterol lowering medication among patients at high cardiovascular disease risk: a qualitative descriptive exploration of patient and general practitioners’ perspectives on a facilitated relay intervention in Alberta, Canada

Organisational culture and the integrated chronic diseases management model implementation fidelity in South Africa: a cross-sectional study

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