Variability in quality of care among dialysis units in western Switzerland.
BACKGROUND
Quality indicators for dialysis care vary across countries and regions, but regional variability across centres has received little attention. We analysed variations in quality indicators among dialysis facilities in western Switzerland to identify opportunities for improving care for patients with end-stage kidney disease.


METHODS
A cross-sectional study of 617 dialysis patients treated at 19 facilities examined the distribution of indicators of quality of care addressing: adequacy of dialysis (Kt/V > or =1.2 for haemodialysis, Kt/V > or =2 for peritoneal dialysis), anaemia control (haemoglobin > or =110 g/l), calcium and phosphate control (product < or =4.4 mmol2/l2), adequate nutrition (serum albumin >35 g/l), hypertension control (pre-dialysis blood pressure <140/90 mmHg) and type of vascular access. Centre quality targets were the following: achievement of quality criteria for 80% of their patients, except 85% for anaemia control and 60% for arterio-venous fistulae.


RESULTS
Most centres fulfilled quality targets for dialysis adequacy, but substantial variations existed among centres (haemodialysis, 76%, range 36-100; peritoneal dialysis, 76%, range 33-100). Results were similar for anaemia (77%, range 35-100), calcium x phosphate product (69%, range 29-92), albumin (63%, range 26-95), hypertension control (33%, range 13-54) and arterio-venous fistula (61%, range 49-92). The between-centre variability was significantly greater than would be expected by chance, for all indicators. Dialysis facilities with >40 patients better fulfilled quality targets than university-based centres. Adjustment for patient characteristics did not modify these results.


CONCLUSIONS
Substantial variations in quality indicators existed between dialysis centres in western Switzerland, which could not be attributed to different centre policies, or to differences in available measures of patient case mix. These findings indicate opportunities for improvement in dialysis practice which may translate into improved clinical outcomes.
Division of Nephrology, University Hospital of Geneva, 1211 Geneva 14, Switzerland. Patrick.Saudan@hcuge.ch
Patrick
P
Saudan
Georges
G
Halabi
Thomas
T
Perneger
Jean-Blaise
JB
Wasserfallen
Michel
M
Kossovsky
Harold
H
Feldman
Pierre-Yves
PY
Martin
Jean-Pierre
JP
Wauters
D000368:Aged; D000740:Anemia / Q000209:etiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D017060:Patient Satisfaction; D010530:Peritoneal Dialysis / Q000592:standards*; D011785:Quality Assurance, Health Care; D006435:Renal Dialysis / Q000592:standards*; D011795:Surveys and Questionnaires; D013557:Switzerland