Identifying Best Practices in Dialysis Care
- 1 July 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 3 (4), 1066-1076
- https://doi.org/10.2215/cjn.04421007
Abstract
Background and objectives: Because there is wide variation in case-mix adjusted outcomes across dialysis facilities, it is possible that top-performing facilities use practices not shared by others. We sought to catalogue “best practices” that may account for interfacility variations in outcomes. Design, setting, participants, & measurements: This multidisciplinary study identified candidate best practices in dialysis through a staged process, including systematic review, cognitive interviews, and a national “virtual focus group” of dialysis providers. The resulting candidate practices were rank-ordered by perceived importance as determined by mean RAND Appropriateness Scores from a national survey of nephrologists, nurses, and opinion leaders. Results: A total of 155 candidate best practices were identified. Among these, respondents believed dialysis outcomes are most strongly related to 1) characteristics of multidisciplinary care conferences, 2) technician proficiency in protecting vascular access, 3) training of nurses to provide education in fluid management, vascular access, and nutrition, 4) use of random and blinded audits of staff performance, and 5) communication and teamwork among staff. In contrast, there was wide disagreement about the importance of facility-based health maintenance practices, optimal staffing ratios, frequency of dialysis-based physician visits, and optimal frequency of multidisciplinary care. Conclusions: This study provides a “conceptual map” of candidate dialysis best practices and highlights areas of general agreement and disagreement. These findings can help the dialysis community think critically about what may define “best practice” and provide targets for future research in quality improvement.This publication has 25 references indexed in Scilit:
- Introduction to the Assessing Care of Vulnerable Elders‐3 Quality Indicator Measurement SetJournal of the American Geriatrics Society, 2007
- Differences in the management of Crohn’s disease among experts and community providers, based on a national survey of sample case vignettesAlimentary Pharmacology & Therapeutics, 2007
- Center Effects in Anemia Management of Dialysis PatientsJournal of the American Society of Nephrology, 2007
- Quality Measures for Symptoms and Advance Care Planning in Cancer: A Systematic ReviewJournal of Clinical Oncology, 2006
- Developing Quality Indicators for Elderly Patients Undergoing Abdominal OperationsJournal of the American College of Surgeons, 2005
- Predictors and consequences of altered mineral metabolism: The Dialysis Outcomes and Practice Patterns StudyKidney International, 2005
- Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): Nutrition guidelines, indicators, and practicesAmerican Journal of Kidney Diseases, 2004
- Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPSNephrology Dialysis Transplantation, 2004
- ACOVE Quality IndicatorsAnnals of Internal Medicine, 2001
- Use of standardized ratios to examine variability in hemodialysis vascular access across facilitiesAmerican Journal of Kidney Diseases, 2000