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Impact of quality improvement initiatives to improve CKD referral patterns: a systematic review protocol
Anukul Ghimire1, Naima Sultana1, Feng Ye1
1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Insights
This systematic review protocol examines quality improvement initiatives for chronic kidney disease (CKD) referrals. It aims to reduce non-guideline-concordant referrals and nephrology wait times for better patient care.
Area of Science:
- Nephrology
- Healthcare Management
- Systematic Review Methodology
Background:
- Chronic kidney disease (CKD) presents a significant global health challenge.
- A substantial number of CKD referrals to nephrologists are premature and do not align with clinical guidelines.
- This can result in an overabundance of referrals and extended waiting periods for specialist consultations.
Purpose of the Study:
- To systematically review the impact of quality improvement initiatives on referral patterns for CKD.
- To assess strategies that increase guideline-concordant referrals to nephrologists.
- To evaluate interventions aimed at reducing wait times for CKD patient access to nephrology care.
Main Methods:
- Protocol developed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) 2015 guidelines.
- Comprehensive search of multiple electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO) and grey literature.
- Inclusion of studies from inception to April 2021, with no language restrictions, focusing on adult CKD referrals to nephrologists.
Main Results:
- This section is not applicable as the output is a protocol for a systematic review, not the results of the review itself.
- The review will synthesize findings from eligible studies to identify effective quality improvement strategies.
- Anticipated outcomes include data on the effectiveness of interventions in optimizing referral appropriateness and reducing wait times.
Conclusions:
- This systematic review protocol outlines a rigorous approach to evaluating quality improvement initiatives in CKD referral management.
- Findings are expected to inform healthcare providers and policymakers on best practices for efficient and guideline-adherent nephrology referrals.
- The study aims to contribute to improved patient outcomes and resource allocation within CKD management.
Introduction:
Chronic kidney disease (CKD) is a global-health problem. A significant proportion of referrals to nephrologists for CKD management are early and guideline-discordant, which may lead to an excess number of referrals and increased wait-times. Various initiatives have been tested to increase the proportion of guideline-concordant referrals and decrease wait times. This paper describes the protocol for a systematic review to study the impacts of quality improvement initiatives aimed at decreasing the number of non-guideline concordant referrals, increasing the number of guideline-concordant referrals and decreasing wait times for patients to access a nephrologist.
Methods And Analysis:
We developed this protocol by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (2015). We will search the following empirical electronic databases: MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO and grey literature for studies designed to improve guideline-concordant referrals or to reduce unnecessary referrals of patients with CKD from primary care to nephrology. Our search will include all studies published from database inception to April 2021 with no language restrictions. The studies will be limited to referrals for adult patients to nephrologists. Referrals of patients with CKD from non-nephrology specialists (eg, general internal medicine) will be excluded.
Ethics And Dissemination:
Ethics approval will not be required, as we will analyse data from studies that have already been published and are publicly accessible. We will share our findings using traditional approaches, including scientific presentations, open access peer-reviewed platforms, and appropriate government and public health agencies.
Prospero Registration Number:
CRD42021247756.
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