USING COMPARATIVE FACILITY REVIEW TO IMPROVE DIALYSIS PATIENT OUTCOMES

Thirty-five dialysis units participated in the ESRD Network 11 Quality Improvement Demonstration, a project designed to test whether facilit y-specific comparative data and Medical Review Committee recommendatio ns would be effective in improving therapeutic outcome for chronic in- center hemodialysis patients. Quality indicators included hematocrit, serum albumin, urea reduction ratio (URR), and a combined calciun/phos phorus indicator. Facility personnel received data summaries comparing their patients' results with those from the other 34 facilities in th e project. Each facility also received recommendations from the Medica l Review Committee. The indicators were remeasured 6 months later. Ove rall results for hematocrit and URR improved, with the most improvemen t occurring in the group of facilities with below-average initial resu lts. Overall results for serum albumin and the combined calcium/phosph orus indicators were stable. When results for all four indicators were considered simultaneously, the group of facilities with the strongest initial results maintained their good performance, while the group of facilities with below-average initial results showed improvement.