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Kidney Int ; 80(10): 1021-34, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21775971

RESUMEN

Recent studies showed wide variation in the extent to which guidelines and other types of best practice have been implemented as part of routine health care. This is also true for the delivery of renal replacement therapy (RRT) for ESRD patients. Increasing uptake of best practice within such complex care systems requires an understanding of implementation strategies and specific quality improvement (QI) techniques. Therefore, we systematically reviewed over 5000 titles published since 1990 and included papers describing planned attempts to accelerate uptake of best RRT practice into daily care. This resulted in a list of 93 QI initiatives, categorized in order to expedite shared learning. The majority of the initiatives were executed within the domains of vascular access, nutrition, and anemia management. Strategies oriented at patients were most common and many initiatives pre-defined an improvement target before starting implementation. Of the 93 initiatives, 22 were sufficiently robust methodologically to be analyzed in more detail. Our results tend to support previous findings that multifaceted strategies are more effective than single strategies. Improving our understanding of how to successfully implement best practice can inform system-level change and is the only way to close the gap between knowledge on what works and the actual care delivered to ESRD patients. Research into implementation, using specific QI techniques, should therefore be given priority in future.


Asunto(s)
Prestación Integrada de Atención de Salud , Fallo Renal Crónico/terapia , Evaluación de Procesos y Resultados en Atención de Salud , Mejoramiento de la Calidad , Terapia de Reemplazo Renal , Benchmarking , Distribución de Chi-Cuadrado , Prestación Integrada de Atención de Salud/normas , Medicina Basada en la Evidencia , Adhesión a Directriz , Humanos , Evaluación de Procesos y Resultados en Atención de Salud/normas , Selección de Paciente , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad/normas , Terapia de Reemplazo Renal/normas , Resultado del Tratamiento
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