• John Humphreys, Gill Harvey, Michelle Coleiro, Brook Butler, Anna Barclay, Maciek Gwozdziewicz, Donal O'Donoghue, and Janet Hegarty.
• NIHR CLAHRC for Greater Manchester, Salford, UK.
• BMJ Qual Saf. 2012 Aug 1; 21 (8): 700-8.

ProblemResearch has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD.DesignA 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives.Setting19 general practices from four primary care trusts within Greater Manchester.Key Measures For ImprovementNumber of recorded patients with CKD on practice registers; percentage of patients on registers achieving nationally agreed blood pressure targets.Strategies For ChangeThe collaborative commenced in September 2009 and involved three joint learning sessions, interspersed with practice level rapid improvement cycles, and supported by an implementation team from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Greater Manchester.Effects Of ChangeAt baseline, the 19 collaborative practices had 4185 patients on their CKD registers. At final data collection in September 2010, this figure had increased by 1324 to 5509. Blood pressure improved from 34% to 74% of patients on practice registers having a recorded blood pressure within recommended guidelines.Lessons LearntEvidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.

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