IMPROVING THE CARE OF PATIENTS TREATED WITH HEMODIALYSIS - A REPORT FROM THE HEALTH-CARE FINANCING ADMINISTRATIONS ESRD CORE INDICATORS PROJECT

To determine the impact of a quality improvement intervention on dialy sis care delivered to hemodialysis patients, we studied 213 hemodialys is facilities in North Carolina, South Carolina, and Georgia, Dialysis adequacy measurements made on two random samples of 30 patients per t reatment center, or all patients if fewer than 30 were treated, select ed in October 1994 (preintervention) and October 1995 (postinterventio n) were used to estimate the facility mean urea reduction ratio (URR) and the proportion of patients with a mean URR less than 50%. The 10% of facilities (n = 22) with the highest proportion of patients with a mean URR less than 50% in the facility at preintervention were selecte d for an intervention that included feedback of facility-specific mean URR, educational programs, a quality improvement workshop, and monito ring until improvement was attained, Changes between preintervention a nd postintervention facility mean URR and proportions of patients with a URR less than 60% and 65% were used to assess the impact of the int ervention, After 1 year, the mean URR had increased an average of 7% i n intervention centers compared with an increase of 1.4% (P < 0.001) i n the remainder of the treatment centers in the Network, There was an average reduction of 17.2% in the proportion of patients with a URR le ss than 65% in intervention centers compared with 4.8% in the other fa cilities (P < 0.001). Comparable reductions in the proportion of patie nts with a mean URR of less than 60% were 16.2% in intervention center s and 2.0% in comparison facilities (P < 0.001). After controlling for facility case mix and other characteristics, the intervention was ind ependently associated with an absolute 2.4% increase in facility-speci fic mean URR, We conclude that the intervention was associated with im provement in hemodialysis care. (C) 1998 by the National Kidney Founda tion, Inc.