title: Monitoring of hemodialysis quality-of-care indicators: why is it important?
abstract: BACKGROUND
  Meeting specific guideline targets is associated with improved survival rates and reduced hospitalizations in the dialysis population. This prospective work evaluated the adequacy of hemodialysis quality indicators in an in-center hemodialysis population with severe comorbidities, and assessed whether clinical practice could impact intermediate outcomes.
  
  
  METHODS
  All the chronic hemodialysis patients treated in Rouen University Hospital hemodialysis Unit between January 2009 and April 2010 were included in this observational study. Every quarter, mean levels and prevalence of conformity were collected for the following indicators: anemia, dialysis dose, serum calcium and phosphorus, PTH, 25OH-vitamin D, albumin, serum bicarbonate, LDL-cholesterol, serum β2-microglobulin, systolic and diastolic blood pressure, intradialytic hypotension and vascular access. Conformity of quality-of-care indicators was determined according to targets defined by international guidelines, whenever available.
  
  
  RESULTS
  Altogether, 124 patients were included in the study. Thirty-three patients were evaluated during the entire follow-up period. An improvement in the percentage of conformity was observed for hemoglobin, dialysis dose, phosphates, PTH, serum bicarbonate and β2-microglobulin in the global population. Failure to improve conformity rates for several indicators, including serum albumin, was found, possibly depending on patients' comorbidities rather than on quality of care.
  
  
  CONCLUSIONS
  Overall, this study shows that following quality-of-care indicators can improve clinical practice by identifying center-specific weaknesses, prompting the establishment of corrective measures. Finally, we suggest that the definition and targets of some indicators, especially hypertension and LDL-cholesterol, be reviewed, since evidence of their association with mortality is not demonstrated.
authors.affiliation: Nephrology department, Rouen University Hospital, 1 Avenue de Germont, 76031 Rouen Cedex, Rouen, France. stevengrange@gmail.com
authors.forename: Steven
authors.initials: S
authors.lastname: Grangé
authors.forename: Mélanie
authors.initials: M
authors.lastname: Hanoy
authors.forename: Frank
authors.initials: F
authors.lastname: Le Roy
authors.forename: Dominique
authors.initials: D
authors.lastname: Guerrot
authors.forename: Michel
authors.initials: M
authors.lastname: Godin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards*