The Commissioning of Quality and Innovation (CQUIN) payment framework established after the “Next Stage Review” conducted by Lord DArzi is supported by the coalition government indeed the current Secretary of State has gone so far as to state that “quality is the only organising principle of the NHS”. CQUINs are one way to achieve that goal.
A range of CQUIN exemplar goals that broadly align with the White Paper “Liberating the NHS” as well as with national Quality Innovation Productivity Prevention workstreams and the nursing high impact actions have been developed to provide well defined evidence based quality improvement goals that can be linked to provider payment through the CQUIN framework.
The renal CQIUNS cover acute kidney injury and home dialysis. The indicators of quality that have been chosen are:
- Percentage of emergency admissions to have both 1. physiological scoring performed to identify patients at high risk of clinical deterioration (eg MEWS score) and 2. senior review (consultant or equivalent within 12 hours of admission).
- Percentage of emergency admissions with a major risk factor for AKI to have both: 1. medication review and 2. serum creatinine re-checked within 24 hours of admission.
- Percentage of patients requiring maintenance dialysis to be receiving home haemodialysis, peritoneal dialysis or assisted automated peritoneal dialysis.
These aren’t ‘must dos’. But they do provide a resource for commissioners, providers, clinicians and patients to draw on when agreeing local CQUIN schemes. Several of the other CQUIN exemplars are relevant to kidney care including those covering transport and care planning in long term conditions. A full set of exemplar CQUIN goals are available shortly from the NHS Institute website (pages 37-39).
As ever, I would be interested in any feedback on their use, how they have been modified locally and views on their impact.