title: A practice-related risk score (PRS): a DOPPS-derived aggregate quality index for haemodialysis facilities.
abstract: BACKGROUND
  The Dialysis Outcomes and Practice Patterns Study (DOPPS) database was used to develop and validate a practice-related risk score (PRS) based on modifiable practices to help facilities assess potential areas for improving patient care.
  
  
  METHODS
  Relative risks (RRs) from a multivariable Cox mortality model, based on observational haemodialysis (HD) patient data from DOPPS I (1996-2001, seven countries), were used. The four practices were the percent of patients with Kt/V > or =1.2, haemoglobin > or =11 g/dl (110 g/l), albumin > or =4.0 g/dl (40g/l) and catheter use, and were significantly related to mortality when modelled together. DOPPS II data (2002-2004, 12 countries) were used to evaluate the relationship between PRS and mortality risk using Cox regression.
  
  
  RESULTS
  For facilities in DOPPS I and II, changes in PRS over time were significantly correlated with changes in the standardized mortality ratio (SMR). The PRS ranged from 1.0 to 2.1. Overall, the adjusted RR of death was 1.05 per 0.1 points higher PRS (P < 0.0001). For facilities in both DOPPS I and II (N = 119), a 0.2 decrease in PRS was associated with a 0.19 decrease in SMR (P = 0.005). On average, facilities that improved PRS practices showed significantly reduced mortality over the same time frame.
  
  
  CONCLUSIONS
  The PRS assesses modifiable HD practices that are linked to improved patient survival. Further refinements might lead to improvements in the PRS and will address regional variations in the PRS/mortality relationship.
authors.affiliation: Humber River Regional Hospital, Weston, Ontario, Canada. dmendelssohn@hrrh.on.ca
authors.forename: David C
authors.initials: DC
authors.lastname: Mendelssohn
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Arrington
authors.forename: Karen E
authors.initials: KE
authors.lastname: Yeates
authors.forename: Martine
authors.initials: M
authors.lastname: Leblanc
authors.forename: Clement
authors.initials: C
authors.lastname: Deziel
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnan
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Norbert
authors.initials: N
authors.lastname: Lameire
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D016208:Databases, Factual; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D018570:Risk Assessment