Susan M Samuel1, Rachel Flynn1, Michael Zappitelli1, Allison Dart1, Rulan Parekh1, Maury Pinsk1, Cherry Mammen1, Andrew Wade1, Shannon D Scott1. 1. Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.
Abstract
BACKGROUND: Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. METHODS: Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. RESULTS: Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. INTERPRETATION: Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. Copyright 2017, Joule Inc. or its licensors.
BACKGROUND: Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. METHODS: Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. RESULTS: Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. INTERPRETATION: Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. Copyright 2017, Joule Inc. or its licensors.
Authors: Shannon D Scott; Heather Sharpe; Kathy O'Leary; Ulrike Dehaeck; Kathryn Hindmarsh; John Garry Moore; Martin H Osmond Journal: Qual Health Res Date: 2009-01
Authors: Debbie S Gipson; Susan F Massengill; Lynne Yao; Shashi Nagaraj; William E Smoyer; John D Mahan; Delbert Wigfall; Paul Miles; Leslie Powell; Jen-Jar Lin; Howard Trachtman; Larry A Greenbaum Journal: Pediatrics Date: 2009-07-27 Impact factor: 7.124
Authors: Rasmus Ehren; Marcus R Benz; Paul T Brinkkötter; Jörg Dötsch; Wolfgang R Eberl; Jutta Gellermann; Peter F Hoyer; Isabelle Jordans; Clemens Kamrath; Markus J Kemper; Kay Latta; Dominik Müller; Jun Oh; Burkhard Tönshoff; Stefanie Weber; Lutz T Weber Journal: Pediatr Nephrol Date: 2021-06-05 Impact factor: 3.714