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Continuous quality improvement in nephrology: a systematic review

View Article: PubMed Central - PubMed

ABSTRACT

Background: Continuous 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.

Methods: Studies 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.

Results: We 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.

Conclusions: Despite 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 material: The online version of this article (doi:10.1186/s12882-016-0389-1) contains supplementary material, which is available to authorized users.

No MeSH data available.


Algorithm for review. *Use of quality improvement with a pre-defined methodology to identify or address clinical, cost, efficiency, safety, communication or process issues within nephrology
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Fig1: Algorithm for review. *Use of quality improvement with a pre-defined methodology to identify or address clinical, cost, efficiency, safety, communication or process issues within nephrology

Mentions: Because definitions of CQI vary, several pre-review meetings of this team were used to define the scope of the review, define the questions we sought to answer and to establish a consensus definition of CQI. From these pre-review meetings we developed an initial algorithm for the review (Fig. 1). Two rounds of piloting the review process occurred whereby all members of the review panel reviewed an initial set of 20 citations, and subsequently met to discuss their independent reviews; the purpose was to clarify questions that arose and refine the review approach where needed. This served to maximize transparency, and ensure consistency in the reviews.Fig. 1


Continuous quality improvement in nephrology: a systematic review
Algorithm for review. *Use of quality improvement with a pre-defined methodology to identify or address clinical, cost, efficiency, safety, communication or process issues within nephrology
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5121952&req=5

Fig1: Algorithm for review. *Use of quality improvement with a pre-defined methodology to identify or address clinical, cost, efficiency, safety, communication or process issues within nephrology
Mentions: Because definitions of CQI vary, several pre-review meetings of this team were used to define the scope of the review, define the questions we sought to answer and to establish a consensus definition of CQI. From these pre-review meetings we developed an initial algorithm for the review (Fig. 1). Two rounds of piloting the review process occurred whereby all members of the review panel reviewed an initial set of 20 citations, and subsequently met to discuss their independent reviews; the purpose was to clarify questions that arose and refine the review approach where needed. This served to maximize transparency, and ensure consistency in the reviews.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Continuous 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.

Methods: Studies 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.

Results: We 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.

Conclusions: Despite 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 material: The online version of this article (doi:10.1186/s12882-016-0389-1) contains supplementary material, which is available to authorized users.

No MeSH data available.