1. The National CKD Audit and Quality Improvement Programme for CKD in Primary Care The project will be advised by key stakeholders, including: From BMJ Informatica, in collaboration with UCL Nephrology LSHTM Clinical Effectiveness Group QMUL RCGP, RCP, RCN Renal Association & Renal Registry Kidney Alliance, Kidney Research UK Informatica Systems Ltd 2013V2.0

2. Aims 1improve identification of CKD in primary care Increase coding Improve testing of ‘at risk’ groups Develop QI tools for better patient management 2improve management of CKD patients not requiring 3improve timely referral of CKD patient requiring specialist review Audit referrals through HES linkage Snapshot of referral pathways across CCGs Develop QI tools to prompt for specialist advice Informatica Systems Ltd 2013 specialist review Audit against NICE targets (eg BP, CV risk assessment, CKD monitoring) Develop QI tools for primary care management V1.0

3. Informatica Systems Ltd 2013V1.0

4. Audit Timeline YEAR 1YEAR TWOYEAR THREE ROUND ONE ROUND TWO Preparations Pilot analysis, toolset adjustment, feedback to practices Full extract Analysis, coding, GP management; hospital referral; link to HES/ONS Pilot Audit & QI tool rollout Informatica Systems Ltd 2013V1.0

5. Outputs Understanding variation In primary care, and pathways into secondary care In patient hospitalisation and outcomes Primary Care Service improvement Practice level data available locally and at CCG level National and regional comparisons to drive improvement Potential Research opportunities Links to other databases e.g. UKRR, MINAP, CPRD Epidemiology, pharmacology, improvement studies Anonymised data available for research groups International comparisons Informatica Systems Ltd 2013 V1.0