NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK; Centre for Health Informatics, The University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre (GMPSTRC), University of Manchester, Manchester, UK.
NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK; Centre for Health Informatics, The University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre (GMPSTRC), University of Manchester, Manchester, UK.
Int J Med Inform. 2021 Jan;145:104299. doi: 10.1016/j.ijmedinf.2020.104299. Epub 2020 Oct 13.
Reducing the harms associated with acute kidney injury (AKI) requires addressing a wide range of patient safety issues, including polypharmacy and transitions of care, particularly for vulnerable patient groups. Computerised audit and feedback can transform the way healthcare organisations measure, analyse and learn from quality and safety data across different care settings, potentially improving patient safety.
To implement and evaluate an audit and feedback dashboard targeting AKI to improve patient safety, focusing on factors affecting a range of user characteristics in primary care.
We performed a mixed methods study in three stages. Semi-structured interviews were initially performed with both primary (n = 10) and secondary care (n = 5) staff to gather user requirements for six quality indicators extracted from national guidance on post-discharge AKI care. Modified indicators were implemented in the Performance Improvement plaN GeneratoR (PINGR) audit and feedback dashboard for six months, across 45 general practices in Salford. Primary care professionals were then interviewed again (n = 7) and completed usability questionnaires. This was triangulated with an interrupted time series analysis on indicator performance, alongside software usage statistics.
Improvements were observed for the indicators for medication review (+9.01 %; 95 % Confidence Interval (CI), +6.95 % to +11.06 %) and blood pressure measurement (+5.20 %; 95 % CI + 3.61 % to +6.78 %). Variable performance and engagement were observed for other indicators including AKI coding (+0.39 %; 95 % CI -1.88 % to +2.65 %), serum creatinine (-3.40 %; 95 % CI -7.66 % to +0.85 %), proteinuria (-1.08 %; 95 % CI -1.47 % to +0.32 %) and providing patient information (+0.16 %; 95 % CI -0.41 % to +0.73 %). A key facilitator to engagement was the development of 'champions of change', achieved through a raised awareness of high-risk patients, guidelines, inconsistencies in coding practice and evidence for quality and safety performance. Barriers related to the specificity and perceived achievability of indicators, and limitations in resources.
In a six-month, quasi-experimental evaluation of an electronic audit and feedback dashboard targeting AKI, we found improvements for two out of six quality indicators. While information technology can facilitate improvements in patient safety, further allocation of protected staff time and investment into shared learning are needed to realise those improvements in practice.
降低急性肾损伤（AKI）相关危害需要解决广泛的患者安全问题，包括多种药物治疗和医疗护理交接，尤其是对于脆弱的患者群体。计算机化的审核和反馈可以改变医疗保健组织在不同医疗环境中衡量、分析和学习质量和安全数据的方式，从而有可能提高患者安全性。
实施并评估针对 AKI 的审核和反馈仪表板，以改善患者安全性，重点关注影响初级保健中各种用户特征的因素。
我们分三个阶段进行了一项混合方法研究。最初对初级保健（n=10）和二级保健（n=5）工作人员进行了半结构化访谈，以收集从国家发布的 AKI 出院后护理指南中提取的六个质量指标的用户需求。修改后的指标在 Performance Improvement plaN GeneratoR（PINGR）审核和反馈仪表板中实施了六个月，在索尔福德的 45 个普通诊所中使用。然后再次对初级保健专业人员（n=7）进行访谈，并完成了可用性问卷调查。这与指标性能的中断时间序列分析以及软件使用统计数据进行了三角测量。
观察到药物审查（+9.01%；95%置信区间（CI），+6.95%至+11.06%）和血压测量（+5.20%；95%CI+3.61%至+6.78%）指标的改善。其他指标的表现和参与度存在差异，包括 AKI 编码（+0.39%；95%CI-1.88%至+2.65%）、血清肌酐（-3.40%；95%CI-7.66%至+0.85%）、蛋白尿（-1.08%；95%CI-1.47%至+0.32%）和提供患者信息（+0.16%；95%CI-0.41%至+0.73%）。参与的一个关键促进因素是“变革的拥护者”的发展，这是通过提高对高危患者、指南、编码实践中的不一致性以及质量和安全绩效的认识来实现的。障碍与指标的特异性和可实现性感知以及资源限制有关。
在针对 AKI 的电子审核和反馈仪表板的为期六个月的准实验评估中，我们发现有两个质量指标得到了改善。虽然信息技术可以促进患者安全的改善，但需要进一步分配受保护的员工时间和投资用于共享学习，以在实践中实现这些改善。
