Continuous quality improvement in nephrology: a systematic review

Abstract

BackgroundContinuous quality improvement (CQI) has been successfully applied in business and engineering for over 60 years. While using CQI techniques within nephrology has received increased attention, little is known about where, and with what measure of success, CQI can be attributed to improving outcomes within nephrology care. This is particularly important as payors’ focus on value-based healthcare and reimbursement is tied to achieving quality improvement thresholds. We conducted a systematic review of CQI applications in nephrology.MethodsStudies were identified from PubMed, MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, ProQuest Dissertation Abstracts and sources of grey literature (i.e., available in print/electronic format but not controlled by commercial publishers) between January 1, 2004 and October 13, 2014. We developed a systematic evaluation protocol and pre-defined criteria for review. All citations were reviewed by two reviewers with disagreements resolved by consensus.ResultsWe initially identified 468 publications; 40 were excluded as duplicates or not available/not in English. An additional 352 did not meet criteria for full review due to: 1. Not meeting criteria for inclusion = 196 (e.g., reviews, news articles, editorials) 2. Not nephrology-specific = 153, 3. Only available as abstracts = 3. Of 76 publications meeting criteria for full review, the majority [45 (61%)] focused on ESRD care. 74% explicitly stated use of specific CQI tools in their methods. The highest number of publications in a given year occurred in 2011 with 12 (16%) articles. 89% of studies were found in biomedical and allied health journals and most studies were performed in North America (52%). Only one was randomized and controlled although not blinded.ConclusionsDespite calls for healthcare reform and funding to inspire innovative research, we found few high quality studies either rigorously evaluating the use of CQI in nephrology or reporting best practices. More rigorous research is needed to assess the mechanisms and attributes by which CQI impacts outcomes before there is further promotion of its use for improvement and reimbursement purposes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0389-1) contains supplementary material, which is available to authorized users.

The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review

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Developing a classification system for haemoglobin management in patients with end-stage renal disease on haemodialysis: a secondary data analysis

“…They allow a valuable overview for long-term patients, and for comparing dialysis centres regarding their patient pool. A classification system like this, integrated into a disease management programme (DMP) for ESRD, as proposed by Rubin et al , 21 or into continuous quality improvement (CQI) as investigated by Nunes et al , 22 could improve and stabilise the quality of care provided to affected patients. Moreover, the classification can be integrated into a clinical decision support system.…”

A National Vision for Quality Improvement in Canadian Nephrology—The Canadian Nephrology Quality Improvement and Implementation Science Collaborative (CN-QUIS): An Opinion Piece

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