Thursday, 10 March 2011

Nice standards if we can achieve them

To mark World Kidney Day the National Institute for Health and Clinical Excellence (NICE) have published the chronic kidney disease (CKD) standards to which the NHS will be held to account. The Information Centre has also uploaded the results showing how different services are performing against the indicators of quality improvement. The quality standards cover the whole of the CKD pathway from risk through early detection and management to reduce vascular risk and progressive kidney injury, preparation, shared decision making, replacement therapy, conservative and end of life care.

Nice quality standards are central to the delivery of quality and improvement in outcomes. The CKD pathway is one of the first NICE quality standards to cover the whole spectrum of disease, some of the other recently published standards only focus on one part of the pathway but as we know healthcare is only as reliable as its weakest link.

CKD is common, harmful and treatable. The recently published Health Survey England data showed that more than 1 in 10 adults have either proteinuria or reduced kidney function as measured by an estimated GFR. Most people remain undetected. Yet we have easy ways to identify kidney disease – simple blood and urine tests that are being performed hundreds of thousands of times a day up and down the country and sometimes ignored. We know for instance that probably only 40% or 50% of those with a reduced GFR are on primary care CKD registers and that overall probably only a third of people with CKD have their blood pressure controlled to the target set by NICE.

The NICE quality standards have been developed by healthcare professionals and patients working together and set the standards of excellence for kidney care. They are aimed at patients, commissioners and service providers as much as healthcare professionals. The standards are based on the best available evidence, much of it drawn from the NICE clinical guideline on chronic kidney disease published in 2008 but augmented by new research findings over the last 3 years. They form the cornerstone of the new NHS Outcomes Framework which sets out the aims and objectives for the NHS.

Most but not all of the standards are relatively easy to measure. We don’t collect national data on all the standards and their power will only be maximised if individual local communities – the kidney community working with primary and secondary care - and commissioners in their local networks use the standards to drive up quality and productivity to achieve value-based kidney care that improves both experience and outcome for patients by engaging the healthcare professionals providing support and management across the CKD pathway and activating patients so they have a better understanding of what kidney disease means for them and how they might reduce their own future risks by lifestyle changes, tailoring the clinical management to the individual and encouraging self care.

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