RESUMO
PROBLEM: Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD. DESIGN: A 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives. SETTING: 19 general practices from four primary care trusts within Greater Manchester. KEY MEASURES FOR IMPROVEMENT: Number of recorded patients with CKD on practice registers; percentage of patients on registers achieving nationally agreed blood pressure targets. STRATEGIES FOR CHANGE: The collaborative commenced in September 2009 and involved three joint learning sessions, interspersed with practice level rapid improvement cycles, and supported by an implementation team from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Greater Manchester. EFFECTS OF CHANGE: At baseline, the 19 collaborative practices had 4185 patients on their CKD registers. At final data collection in September 2010, this figure had increased by 1324 to 5509. Blood pressure improved from 34% to 74% of patients on practice registers having a recorded blood pressure within recommended guidelines. LESSONS LEARNT: Evidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.