Effect of a quality improvement strategy on several haemodialysis outcomes.
BACKGROUND
Intermediate outcomes are associated with the survival of long-term haemodialysis patients; however, outcome variability across centres may result in heterogeneous quality of care. The study aim was to evaluate a multifaceted quality improvement activity (QIA) targeting several haemodialysis clinical performance measures.


METHODS
A total (prevalent and incident) of 313 patients from four dialysis units were included. The QIA was based on a multifaceted strategy involving collection of haemodialysis clinical performance measures every 6-8 months, feedback about results, improvement plans and benchmarking, and it was tested in a 3-year prospective interventional study. Two timepoints of clinical performance measures were considered for evaluating the QIA: baseline (February 2003, pre-QIA) and final (February 2006, post-QIA).


RESULTS
Centres showed significant improvement in percentage of patients with haemoglobin <11 g/dl, mean haemoglobin; percentage of patients with Kt/v <1.2, mean Kt/v; percentage of patients with phosphorous >5.5 mg/dl, mean phosphorous; percentage of patients with calcium phosphate product >55, mean calcium phosphate product; and percentage of patients with ferritin <200 ng/ml, mean ferritin. No change was observed in percentage of patients with haemoglobin between 11 and 13 g/dl, erythropoietin consumed; percentage of patients with ferritin <100 ng/ml; percentage of patients with ferritin >800 ng/ml; percentage of patients with albumin <3.5 g/dl, mean albumin; or percentage of native arteriovenous fistula. The percentage of patients with haemoglobin >13 g/dl was increased.


CONCLUSIONS
Quality-improvement strategies can help improve haemodialysis performance for anaemia, dialysis dose and bone metabolism. The importance of assessing patients with high haemoglobin level should be stressed.
Parra
Eduardo
E
Unidad de Nefrología, Hospital Reina Sofía de Tudela, Carretera de Tarazona Km 3, 31500 Tudela, Spain. eparramo@cfnavarra.es
Ramos
Rosa
R
Betriu
Angels
A
Paniagua
José
J
Belart
Montse
M
Martínez
Tomás
T
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000517:prevention & control; D019985:Benchmarking; D002130:Calcium Phosphates / Q000378:metabolism; D005260:Female; D006436:Hemodialysis Units, Hospital; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D008875:Middle Aged; D009752:Nutritional Status; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D006435:Renal Dialysis / Q000592:standards* / Q000706:statistics & numerical data; D013030:Spain; D016896:Treatment Outcome
D002130:Calcium Phosphates; D006454:Hemoglobins; D010758:Phosphorus; C020243:calcium phosphate