Measurement and Understanding Workstream, KQuIP
Quality improvement (QI) frequently measures how variables change either:
- To identify and respond to unwanted variation or
- To measure the impact of implementing a change into day-to-day healthcare practice.
It is often used as a bridge between research and day-to-day practice, observing the true effect of implementing an intervention into the real world. Often changes can lead to improvement in clinical outcomes, but be detrimental to how patients’ feel about their care or condition. Renal patients undergo a huge burden of treatment, so it is important that interventions and changes do not make this worse. Focussing purely on clinical outcomes often misses essential advantages or detrimental effects of interventions for patients. Ultimately we want to improve both clinical outcomes and patient experience, not one at the cost of the other.
Therefore, a broad QI measurement strategy is necessary, that includes patient experience, outcomes important to patients and / or the effect on overall quality of life, alongside clinical outcomes. This allows proper assessment of the practical advantages and disadvantages of the change or intervention from all perspectives.
Following the release of information on various renal relevant measurement tools for QI in the renal setting, the measurement and understanding workstream identified the ICECAP measures (Investigating Choice Experiments CAPability) are a useful addition to this selection. ICECAP is used to measure an individual’s wellbeing in terms of their ability to ‘do’ and ‘be’ the things that are important in life. Further information about the ICECAP measures (ICECAP-A for adults and ICECAP-O for older people) is provided in the ICECAP proforma for renal relevant measurement tools.
Two members of the measurement and understanding workstream, Paul Mitchell and Lina Johansson, have experience of using ICECAP within renal research projects.
Paul Mitchell, a health economist who has been working with the UK Renal Registry in Bristol for the past two years, talks about his experience of using the ICECAP measures with renal patients:
‘My research is looking to understand which of the ICECAP measures (ICECAP-A for adults, ICECAP-O for older people) should be used for patients with kidney problems. I interviewed 30 patients who were attending renal outpatients for kidney checks or kidney transplants, as well as patients receiving dialysis. Although analysis of my research project is currently ongoing, based on my experience of conducting the interviews, most patients found the ICECAP measures easy to understand and complete. For quality improvement projects, choosing an ICECAP measure could be advantageous over other measures if the aim of the project is to improve a person’s ability to do things in life that matter to them and not just improvements in their physical health.’
Lina Johansson, a clinical academic renal dietitian has used ICECAP-O as a secondary outcome measure in her research in older people with advanced chronic kidney disease. The aim of the research was to determine if nutritional input influenced outcomes over a two year period, with the ICECAP-O qualifying wellbeing in items that are of particular relevance to older people. The measurement was undertaken six monthly in 80 older adults ranging from 65 to ≥90 years. The measure was quick to undertake (minutes) and the participants mostly were able to understand the questions. The results are still being analysed and should provide an indication if the levels are sensitive enough to detect change over a two year timeframe.
Whilst these measures have currently been applied in the research setting, this measure is relevant to QI too. From the research evidence base, QI projects can utilise this tool knowing it is relevant, reliable and valid for renal patients. This tool then brings a dimension to measurement that is beyond clinical outcome measures, which as mentioned earlier is essential for QI.
Measurement tools like ICECAP and others identified through the KQuIP hub aim to inspire healthcare professionals to think beyond clinical outcomes and achieve a fuller measurement strategy. Following on from this ethos, the measurement and understanding workstream are exploring how the tools developed and identified through ‘Transforming Participation in CKD’ can be used in QI projects.