title: Guidelines audit may overcome disparities in health care: experience of an Italian region.
abstract: BACKGROUND
  A clinical audit is used to verify the application of evidence-based clinical guidelines. Our regional section of the Italian Society of Nephrology was the first to establish a region-based program of clinical audits of compliance with guidelines for treating osteodystrophy and anemia of patients on chronic dialysis. This study summarizes the main results of the 2 audits of the Piemonte region.
  
  
  METHODS
  Structured questionnaires were sent twice to all of the 22 dialysis centers of Piemonte and to the Center of Valle D'Aosta for an Audit on Osteodystrophy (in 2000 and 2004) and for the Audit on Anemia (2003). The questionnaires were meant to evaluate the clinical schedule of treatment relative to calcium-phosphate balance and anemia in dialysis patients.
  
  
  RESULTS
  All centers responded, showing low levels of agreement with the targets of Italian guidelines. In sum, in 2000 only 27% of centers had more than 70% of patients with serum phosphate <5.5 mg/dL, but that rate had increased to 33% in 2004. Only 35% (in 2000) and 40% (in 2004) of the centers had more than 90% of patients with Kt/V >1.2. The Audit on Anemia showed a median of 42% of patients with hemoglobin between 11 and 12 g/dL, and only 2 centers had more than 70% of patients above this target.
  
  
  CONCLUSIONS
  The first result of our pioneering experience was that we found that compliance with minimal levels of care was still inadequate, with regard to hyperphosphatemia, dialysis adequacy and anemia. Nevertheless, the 2nd Audit on Osteodystrophy showed a relative improvement in the results. But, most importantly, this open regional report has encouraged comparisons, and motivated centers to adopt a strategy of understanding, addressing and correcting inadequate levels of care, and furthermore increased satisfaction with the care being offered.
authors.affiliation: Service of Nephrology, C.T.O./C.R.F./M. Adelaide Hospital, Torino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Salomone
authors.forename: Caterina
authors.initials: C
authors.lastname: Canavese
authors.forename: Daniela
authors.initials: D
authors.lastname: Bergamo
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Hollo
authors.forename: Daniele
authors.initials: D
authors.lastname: Damiani
authors.forename: Stefano
authors.initials: S
authors.lastname: Maffei
authors.forename: Roberta
authors.initials: R
authors.lastname: Fenoglio
authors.forename: Francesca
authors.initials: F
authors.lastname: Bermond
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cantaluppi
authors.forename: Marco
authors.initials: M
authors.lastname: Quaglia
authors.forename: Giorgio
authors.initials: G
authors.lastname: Triolo
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications / Q000628:therapy*