You are here

Article Text

Article menu
Renal medicine
Protocol
Impact of quality improvement initiatives to improve CKD referral patterns: a systematic review protocol
  1. Anukul Ghimire1,
  2. Naima Sultana1,
  3. Feng Ye1,
  4. Laura N Hamonic1,
  5. Allan K Grill2,
  6. Alexander Singer3,
  7. Ayub Akbari4,
  8. Branko Braam1,
  9. David Collister5,6,
  10. Kailash Jindal1,
  11. Mark Courtney1,
  12. Nikhil Shah1,
  13. Paul E Ronksley7,
  14. Sabin Shurraw1,
  15. Kenneth Scott Brimble6,
  16. Scott Klarenbach1,
  17. Sophia Chou7,
  18. Soroush Shojai1,
  19. Vinay Deved1,
  20. Andrew Wong8,
  21. Ikechi Okpechi1,
  22. A K Bello1
  1. 1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  4. 4Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  5. 5Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  7. 7Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  8. 8Callingwood Medical Center, Edmonton, Alberta, Canada
  1. Correspondence to Dr A K Bello; aminu1{at}ualberta.ca

Abstract

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.

  • chronic renal failure
  • epidemiology
  • primary care
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-055456

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Twitter @dr_nikhilshah, @S_brimble

    • Contributors AG, NS, FY, IO and AKB developed the concept and drafted the manuscript. FY produced figures for manuscript. LNH drafted the search strategy. NS registered the study with PROSPERO. LNH, AKG, AS, AA, BB, DC, KJ, MC, NS, PER, SaS, KSB, SK, SC, SoS, VD and AW were involved in developing the protocol methods and revising the manuscript. All authors approved the final version to be published.

    • Funding This work is supported by a Canadian Institutes of Health Research (CIHR) Project Scheme Grant (grant number: RES0046966) and AMGEN Canada Incorporated Clinical Innovation Grant (grant number: RES0041633) awarded to AKB.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.