TY - JOUR
T1 - Improving the care of patients treated with hemodialysis
T2 - A report from the health care financing administration's core indicators project
AU - McClellan, William M.
AU - Soucie, J. Michael
AU - Krisher, Jenna
AU - Caruana, Ralph
AU - Haley, William
AU - Farmer, Charles
PY - 1998/4
Y1 - 1998/4
N2 - To determine the impact of a quality improvement intervention on dialysis care delivered to hemodialysis patients, we studied 213 hemodialysis facilities in North Carolina, South Carolina, and Georgia. Dialysis adequacy measurements made on two random samples of 30 patients per treatment center, or all patients if fewer than 30 were treated, selected in October 1994 (preintervention) and October 1995 (postintervention) were used to estimate the facility mean urea reduction ratio (URR) and the proportion of patients with a mean URR less than 50%. The 10% of facilities (n = 22) with the highest proportion of patients with a mean URR less than 50% in the facility at preintervention were selected for an intervention that included feedback of facility-specific mean URR, educational programs, a quality improvement workshop, and monitoring until improvement was attained. Changes between preintervention and postintervention facility mean URR and proportions of patients with a URR lass then 60% and 65% were used to assess the impact of the intervention. After 1 year, the mean URR had increased an average of 7% in intervention centers compared with an increase of 1.4% (P < 0.001) in the remainder of the treatment centers the Network. There was an average reduction of 17.2% in the proportion of patients with a URR less then 65% intervention canters compared with 4.8% in the other facilities (P < 0.001). Comparable reductions in the proportion of patients with a mean URR of less than 60% were 16.2% in intervention centers and 2.0% in comparison facilities (P < 0.001). After controlling for facility case mix and other characteristics, the intervention was independently associated with an absolute 2.4% increase in facility-specific mean URR. We conclude that the intervention was associated with improvement in hemodialysis care.
AB - To determine the impact of a quality improvement intervention on dialysis care delivered to hemodialysis patients, we studied 213 hemodialysis facilities in North Carolina, South Carolina, and Georgia. Dialysis adequacy measurements made on two random samples of 30 patients per treatment center, or all patients if fewer than 30 were treated, selected in October 1994 (preintervention) and October 1995 (postintervention) were used to estimate the facility mean urea reduction ratio (URR) and the proportion of patients with a mean URR less than 50%. The 10% of facilities (n = 22) with the highest proportion of patients with a mean URR less than 50% in the facility at preintervention were selected for an intervention that included feedback of facility-specific mean URR, educational programs, a quality improvement workshop, and monitoring until improvement was attained. Changes between preintervention and postintervention facility mean URR and proportions of patients with a URR lass then 60% and 65% were used to assess the impact of the intervention. After 1 year, the mean URR had increased an average of 7% in intervention centers compared with an increase of 1.4% (P < 0.001) in the remainder of the treatment centers the Network. There was an average reduction of 17.2% in the proportion of patients with a URR less then 65% intervention canters compared with 4.8% in the other facilities (P < 0.001). Comparable reductions in the proportion of patients with a mean URR of less than 60% were 16.2% in intervention centers and 2.0% in comparison facilities (P < 0.001). After controlling for facility case mix and other characteristics, the intervention was independently associated with an absolute 2.4% increase in facility-specific mean URR. We conclude that the intervention was associated with improvement in hemodialysis care.
KW - Continuous quality Improvement
KW - Dialysis adequacy
KW - ESRD
KW - Urea reduction ratio
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U2 - 10.1053/ajkd.1998.v31.pm9531173
DO - 10.1053/ajkd.1998.v31.pm9531173
M3 - Article
C2 - 9531173
AN - SCOPUS:0031944021
SN - 0272-6386
VL - 31
SP - 584
EP - 592
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -