title: Improving adequacy of peritoneal dialysis in ESRD Network 5 (Maryland; Washington, DC; Virginia; West Virginia).
abstract: The goal of the quality improvement project reported here was to increase the proportion of peritoneal dialysis (PD) patients receiving adequate dialysis as defined by the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines. Our approach was to increase the frequency with which we measured PD adequacy and changed prescriptions in response to low adequacy values. We developed 3 indicators, each one subdivided to reflect differences by type of PD and time on PD. Our improvement goal was to achieve the midpoint between baseline performance on those indicators and 100%, equating to a 50% reduction in failure rate (RFR). At baseline, the project included 122 facilities with 1,517 patients (data from October 1999 to March 2000). At re-measurement, we had 117 facilities with 1,372 patients (data from January 2001 to June 2001). In addition to obtaining facility-specific feedback reports, we conducted educational intervention workshops to which all PD providers were invited. After the workshops, "mandatory intervention" facilities submitted improvement plans that were reviewed by the PD Adequacy Work Group to determine if improvement actions were appropriately focused on identified root causes. Not all intervention facilities attended the workshops, and some facilities attended voluntarily. Overall, the Network 5 results showed a statistically significant improvement in measuring PD adequacy (84% baseline to 92% re-measurement), with a corresponding 51% RFR. Improvement in desired levels of adequacy was also statistically significant (55% baseline to 64% re-measurement), with a 21% RFR. Analysis by the intervention group showed that "mandatory intervention" facilities improved more than did "voluntary" facilities in measuring adequacy and in reaching desired levels, and that the differences were statistically significant. Quality improvement efforts that focused on improving the adequacy of PD in Network 5 were accomplished.
authors.affiliation: Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Gehr
authors.forename: Filitsa
authors.initials: F
authors.lastname: Bender
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fink
authors.forename: Paul
authors.initials: P
authors.lastname: Light
authors.forename: Karen
authors.initials: K
authors.lastname: Elliott
authors.forename: Christie
authors.initials: C
authors.lastname: Shield
authors.forename: Mary
authors.initials: M
authors.lastname: Turner
authors.forename: Cathy
authors.initials: C
authors.lastname: Mays
authors.forename: Joan
authors.initials: J
authors.lastname: Parrish
authors.forename: Nancy
authors.initials: N
authors.lastname: Armistead
mesh_terms: D004219:District of Columbia; D019983:Guideline Adherence; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008396:Maryland; D010530:Peritoneal Dialysis / Q000592:standards; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D014768:Virginia; D014903:West Virginia