title: Utility of the advanced chronic kidney disease patient management tools: case studies.
abstract: 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.
authors.affiliation: Department of Medicine, Duke Center for Clinical Health Policy Research, Duke University Medical Center, Durham NC 27705, USA. mechpatw@gmail.com
authors.forename: Meenal B
authors.initials: MB
authors.lastname: Patwardhan
authors.forename: David B
authors.initials: DB
authors.lastname: Matchar
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Samsa
authors.forename: William E
authors.initials: WE
authors.lastname: Haley
mesh_terms: D000368:Aged; D019090:Case Management / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019982:Organizational Case Studies; D017410:Practice Guidelines as Topic; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration