Acute Kidney Injury - Basic Research and Clinical Practice. Группа авторов
Чтение книги онлайн.

Читать онлайн книгу Acute Kidney Injury - Basic Research and Clinical Practice - Группа авторов страница 8

СКАЧАТЬ target="_blank" rel="nofollow" href="#ulink_88d61ddf-be13-5df0-bc2c-c836553b68cc">5]. Recent data suggest that AKI has consequences not only during the acute phase, but also in long-term phases, resulting in progressive chronic kidney disease [6] and end-stage kidney disease requiring dialysis or kidney transplantation [5, 7, 8].

      Quality Measurement and AKI Risk Assessment

      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.

Img

      The Methodology of Quality Measure in AKI Risk Assessment

      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