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. 2017 Aug 25:4:2054358117725295.
doi: 10.1177/2054358117725295. eCollection 2017.

Attitudes and Opinions of Canadian Nephrologists Toward Continuous Quality Improvement Options

Carina Iskander  1 , Rory McQuillan  2 , Gihad Nesrallah  3 , Christian Rabbat  4 , David C Mendelssohn  3
Affiliations

Attitudes and Opinions of Canadian Nephrologists Toward Continuous Quality Improvement Options

Carina Iskander et al. Can J Kidney Health Dis. .

Abstract
in English, French

Background and objectives: A shift to holding individual physicians accountable for patient outcomes, rather than facilities, is intuitively attractive to policy makers and to the public. We were interested in nephrologists' attitudes to, and awareness of, quality metrics and how nephrologists would view a potential switch from the current model of facility-based quality measurement and reporting to publically available reports at the individual physician level.

Design setting participants and measurements: The study was conducted using a web-based survey instrument (Online Appendix 1). The survey was initially pilot tested on a group of 8 nephrologists from across Canada. The survey was then finalized and e-mailed to 330 nephrologists through the Canadian Society of Nephrology (CSN) e-mail distribution list. The 127 respondents were 80% university based, and 33% were medical/dialysis directors.

Results: The response rate was 43%. Results demonstrate that 89% of Canadian nephrologists are engaged in efforts to improve the quality of patient care. A minority of those surveyed (29%) had training in quality improvement. They feel accountable for this and would welcome the inclusion of patient-centered metrics of care quality. Support for public reporting as an effective strategy on an individual nephrologist level was 30%.

Conclusions: Support for public reporting of individual nephrologist performance was low. The care of nephrology patients will be best served by the continued development of a critical mass of physicians trained in patient safety and quality improvement, by focusing on patient-centered metrics of care delivery, and by validating that all proposed new methods are shown to improve patient care and outcomes.

Contexte et objectifs de l’étude: Une transition vers l’attribution de la responsabilité des résultats des patients au médecin traitant plutôt qu’à l’établissement de soins de santé est un concept attrayant pour les décideurs et le grand public. Notre objectif d’étude était bipartite: d’abord, nous voulions explorer la perception et la connaissance qu’ont les néphrologues des indicateurs de la qualité des soins; ensuite, nous souhaitions prendre connaissance de l’avis des néphrologues sur un éventuel changement de modèle, lequel évalue actuellement la qualité des soins de manière globale plutôt que pour chaque médecin et enfin, sur l’idée que de tels rapports individuels soient accessibles au public.

Conception et cadre de l’étude participants et méthodologie: L’étude a été réalisée à l’aide d’un sondage Web (voir l’annexe 1). Une version provisoire du sondage a d’abord été testée auprès de huit néphrologues de partout au Canada. La version définitive du sondage a été envoyée par courriel à 330 néphrologues figurant sur la liste d’envoi de la Société canadienne de néphrologie (SCN). Le taux de réponse global a été de 43%. Des 127 répondants, la grande majorité (80%) travaillait en milieu universitaire et 33% occupait un poste de directeur médical ou de directeur d’unité de dialyse.

Résultats: Les résultats ont démontré que 89% des néphrologues canadiens s’efforcent déjà d’améliorer les soins prodigués aux patients, et qu’une minorité d’entre eux (29%) ont reçu une formation pertinente. De manière générale, ils se sentent responsables de la qualité des soins et sont réceptifs à l’idée d’inclure des critères d’évaluation plus axés sur les patients. Le taux d’approbation en regard de l’accès libre aux rapports individuels comme une stratégie efficace au plan individuel était de 30%.

Conclusion: Un faible pourcentage des néphrologues s’est prononcé en faveur de la divulgation publique de rapport faisant état de leur performance individuelle. Les soins prodigués aux patients suivis en néphrologie seront perfectionnés en continuant d’augmenter le nombre de médecins formés en matière d’amélioration de la qualité des soins aux patients et de sécurité, en promouvant des indicateurs de qualité centrés sur les patients, et en vérifiant que toute nouvelle méthode proposée vise foncièrement à améliorer les soins ou les résultats des patients.

Keywords: Canada; quality; reporting; survey.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Distribution of responses to the statement: “To what degree do you agree with the following statements about quality improvement in nephrology.”
Figure 2.
Figure 2.
Distribution of responses, as applied to predialysis, incenter, and home dialysis care, to the statements: (A) In my opinion, there are some appropriate and valid measures that should form a basis for CQI activities; (B) Shifting from program to physician level measurement and reporting is likely to improve quality of care; (C) Participation of multiple physicians in the shared care of patients could confound physician specific measures; (D) Participation of nurses and/or other nonmedical professional staff in the shared care of patients could confound physician specific measures.
Figure 3.
Figure 3.
Distribution of responses to the statement: “To what degree do you agree with the following statements about quality improvement in nephrology.”
Figure 4.
Figure 4.
Distribution of responses to the statement: “To what degree do you agree with the following statements about quality improvement in nephrology.”
See this image and copyright information in PMC

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