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This version was published on April 1, 2008
American Journal of Medical Quality, Vol. 23, No. 2, 105-114 (2008)
DOI: 10.1177/1062860607313142

Utility of the Advanced Chronic Kidney Disease Patient Management Tools: Case Studies

Meenal B. Patwardhan, MD

Department of Medicine, Duke Center for Clinical Health Policy Research, Duke University Medical Center, and the Veterans Administration Health Services Research, mechpatw{at}gmail.com

David B. Matchar, MD

Department of Biostatistics and Bioinformatics, Veterans Administration Medical Center, Department of Medicine, Duke Center for Clinical Health Policy Research, Duke University Medical Center

Gregory P. Samsa, PhD

Department of Medicine, Duke Center for Clinical Health Policy Research, Duke University Medical Center, Duke University, Durham, North Carolina

William E. Haley, MD

Mayo Clinic College of Medicine, Rochester, Minnesota, Mayo Clinic Division of Nephrology and Hypertension, Jacksonville, Florida

Appropriate management of advanced chronic kidney disease (CKD) delays or limits its progression. The Advanced CKD Patient Management Toolkit was developed using a process-improvement technique to assist patient management and address CKD-specific management issues. We pilot tested the toolkit in 2 community nephrology practices, assessed the utility of individual tools, and evaluated the impact on conformance to an advanced CKD guideline through patient chart abstraction. Tool use was distinct in the 2 sites and depended on the site champion's involvement, the extent of process reconfiguration demanded by a tool, and its perceived value. Baseline conformance varied across guideline recommendations (averaged 54%). Posttrial conformance increased in all clinical areas (averaged 59%). Valuable features of the toolkit in real-world settings were its ability to: facilitate tool selection, direct implementation efforts in response to a baseline performance audit, and allow selection of tool versions and customizing them. Our results suggest that systematically created, multifaceted, and customizable tools can promote guideline conformance. (Am J Med Qual 2008; 23:105-114)

Key Words: chronic kidney disease • guideline implementation • implementation tools • quality improvement


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