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Mixed methods evaluation of a computerised audit and feedback dashboard to improve patient safety through targeting acute kidney injury (AKI) in primary care
International Journal of Medical Informatics ( IF 4.9 ) Pub Date : 2020-10-13 , DOI: 10.1016/j.ijmedinf.2020.104299
Jung Yin Tsang 1 , Benjamin Brown 1 , Niels Peek 2 , Stephen Campbell 3 , Thomas Blakeman 3
Affiliation  

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.



中文翻译:

计算机化审计和反馈仪表板的混合方法评估,通过针对初级保健中的急性肾损伤 (AKI) 来提高患者安全

背景

减少与急性肾损伤 (AKI) 相关的危害需要解决广泛的患者安全问题,包括多药治疗和护理过渡,特别是对于弱势患者群体。计算机化的审计和反馈可以改变医疗保健组织在不同护理环境中测量、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。

客观的

实施和评估针对 AKI 的审计和反馈仪表板以提高患者安全,重点关注影响初级保健中一系列用户特征的因素。

方法

我们分三个阶段进行了混合方法研究。最初对初级 (n = 10) 和二级护理 (n = 5) 工作人员进行了半结构化访谈,以收集用户对从国家出院后 AKI 护理指南中提取的六项质量指标的要求。修改后的指标在索尔福德的 45 个一般实践中实施了六个月的绩效改进计划生成器 (PINGR) 审计和反馈仪表板。然后再次采访初级保健专业人员 (n = 7) 并完成可用性问卷。这是通过对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三角测量的。

结果

观察到药物审查指标(+9.01 %;95 % 置信区间 (CI),+6.95 % 至 +11.06 %)和血压测量指标(+5.20 %;95 % CI + 3.61 % 至 +6.78 %)的改善. 对于其他指标,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 %)并提供患者信息(+0.16 %;95 % CI −0.41 % 至 +0.73 %)。参与的一个关键促进因素是“变革倡导者”的发展,这是通过提高对高风险患者的认识、指南、编码实践中的不一致以及质量和安全绩效的证据来实现的。障碍与指标的特异性和感知的可实现性以及资源的限制有关。

结论

在针对 AKI 的电子审计和反馈仪表板进行的为期六个月的准实验评估中,我们发现六个质量指标中的两个有所改进。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员工的时间和投资于共享学习,以在实践中实现这些改进。

更新日期:2020-10-30
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