Variability in quality of care among dialysis units in western Switzerland

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It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.
Serval ID
serval:BIB_DDF86C0163C0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Variability in quality of care among dialysis units in western Switzerland
Journal
Nephrology, Dialysis, Transplantation
Author(s)
Saudan  P., Halabi  G., Perneger  T., Wasserfallen  J. B., Kossovsky  M., Feldman  H., Martin  P. Y., Wauters  J. P.
ISSN
0931-0509 (Print)
Publication state
Published
Issued date
09/2005
Volume
20
Number
9
Pages
1854-63
Notes
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't --- Old month value: Sep
Abstract
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.
Keywords
Aged Anemia/etiology/therapy Cross-Sectional Studies Female Humans Kidney Failure, Chronic/etiology/*therapy Male Middle Aged Nutrition Assessment Patient Satisfaction Peritoneal Dialysis/*standards Quality Assurance, Health Care Questionnaires Renal Dialysis/*standards Switzerland
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2008 15:13
Last modification date
25/09/2019 7:11
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