Acute Kidney Injury - Basic Research and Clinical Practice. Группа авторов
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Название: Acute Kidney Injury - Basic Research and Clinical Practice
Автор: Группа авторов
Издательство: Ingram
Жанр: Медицина
Серия: Contributions to Nephrology
isbn: 9783318063110
isbn:
Recognizing this, the International Society of Nephrology (ISN) set a goal of eliminating preventable or treatable death from AKI by 2025, the “0 by 25” initiative [9]. However, the implementation of this scheme requires full consideration of the quality measure throughout the AKI management, and risk assessment is the first stage.
Quality Measurement and AKI Risk Assessment
Quality and safety are factors that are increasingly becoming important to be fulfilled in medicine. However, a formalized pattern has been emphasized to implement and monitor measures to assess the quality and safety of care delivered to patients. Quality and safety are critical priorities in the care of critically ill patients. For patients with AKI, measures and outcomes associated with quality of care have been increasingly important. Priorities for improving quality of care incorporate many important aspects including risk assessment, early diagnosis, monitoring, and strategies for management. Some quality improvements have been reported focusing on AKI management [10, 11]. These have contributed to the development of a consensus diagnosis for AKI and clinical practice guidelines for AKI. However, recent literature showed that the quality of care received by patients with AKI remains poor in some underdeveloped countries [12], and this may increase morbidity and mortality associated with iatrogenic complications and suboptimal quality of care [13].
The risk factors for AKI are well estimated [14–19]. This leads to the recommendation that all admissions should undertake an AKI risk assessment so that modifiable risks factors can be identified and attenuated in a timely phase. The issue of preventability is critical, as the costs associated with AKI are high, both in the short and long term [20].
Framing AKI as a driver of substantial inequity in disease risk and mortality in developing countries, the ISN has created and launched the multifaceted human rights program “0 by 25,” which advocates that no one should die of untreated AKI, with a focus on low- and middle-income countries in Africa, Asia and Latin America [8]. In the 5-R approach proposed by “The ISN 0 by 25” project: risk assessment, recognition, response, renal support and rehabilitation, the first 3 Rs focus on the prevention area. Similarly, we must focus on simplifying every step to allow primary care providers to implement these measures regardless of their work environment. Thus, the quality of AKI risk assessment with proper measure applied is priority.
Fig. 1. Plan, Do, Study, Act (PDSA) circle model. Plan = the change to be tested or implemented. Do = carry out the test or change. Study = data before and after the change and reflect on what was learned. Act = plan the next change cycle or full implementation.
The Methodology of Quality Measure in AKI Risk Assessment
In hospitals, new ideas are often developed without sufficient testing. So the Plan, Do, Study, Act (PDSA) circle model (Fig. 1) has been widely introduced to the practitioner, for testing its feasibility and possible improvement measures that can be achieved before applying this model widely.
The PDSA circle is significant in its use to improve the quality of recognizing AKI early. It works best when it is used to test ideas on a small scale prior to full implementation. With quality improvement services, there will be multiple consecutive cycles used alongside project development. The model is based on the scientific method of encompassing a planned, systematic means to solving a problem that can be observed. Outcomes will be measured, but unlike research, the outcome measures in this model are tools for learning and demonstrating improvement, and are not to be evaluated against research criteria. This model works as a practical framework to evaluate the current service and to test and generate new ideas for the development of an AKI risk assessment. We discuss an example below.
Plan
Before AKI is diagnosed, certain risk factors shall be screened based on the patient’s manifestation and underlying complication or disease. An algorithm comprising common risk factors shall be designed for early identification. The improvement of this method is supposed to be significant.
Do
All the clinical practitioners shall regard AKI as acute myocardial infarction, which means wherever the patients visit, community hospitals or tertiary hospital setting, certain AKI symptom or manifestation may recall doctors to screen-related risk factors according to the algorithm.
Study
Comparison between before and after the implementation shall be done to identify whether or not it is beneficial.
Act
It depends on the evaluation from the last step. If the algorism is good enough, the laboratory factors shall be considered for better assessment of AKI risk.
PDSA approach can be utilized as an effective tool in the initial stages of developing an intervention to evaluate the current service delivery of the management of AKI and to generate and test ideas prior to implementation. This approach is simple and logical to use for members of the multidisciplinary team and allows for effective reporting and documentation of the development process in service improvement projects.
Existing Literature of Quality Measure in AKI Risk Assessment
National institute for health and care excellence published guidelines [21] for ensuring quality and safety in AKI. They were developed with rigorous methodology. Specific questions were raised in a population, intervention, comparison, outcome framework. These guidelines were created indicating that most of AKI is preventable, and that the risk assessment, prevention, and early recognition are key factors to decrease the incidence of AKI, prevalence of chronic kidney disease and related death.
In the recommendations for assessing the risk of AKI, suggestions are classified according to specific patients (Fig. 2).
On the other hand, Rizo-Topete et al. [22] encourage every health care provider to perform СКАЧАТЬ