Why do some dialysis centers have higher survival rates?

Sep 30, 2010

Characteristics such as patient engagement, physician communication, and staff coordination may help to explain why some dialysis centers achieve higher patient survival rates than others, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

"The purpose of this study was simple: to figure out what top-performing dialysis units might be doing differently from bottom-performing units, and to translate those findings into a blueprint for action," comments Brennan M.R. Spiegel, MD, MSHS (VA Greater Los Angeles Healthcare System). "We identified many factors that may enhance survival in dialysis, and we hope our findings can pave the way for future quality improvement initiatives."

The researchers surveyed clinical staff members at 90 dialysis centers within three large dialysis organizations about center characteristics that could potentially affect patient outcomes. "We focused on a wide range of factors, including patient-level, provider-level, and facility-level characteristics," says Spiegel.

Nineteen unique characteristics were found to be associated with lower-than-expected mortality rates. These characteristics remained significant even after adjustment for "case mix" factors affecting mortality risk.

Staff at centers with above-expected survival rates reported that their patients were more "engaged" in their own care. Top-performing centers also reported stronger physician communication skills and interpersonal relationships.

The top-performing dialysis centers also had superior coordination and staff management and dietitians who were "more resourceful and knowledgeable. "Altogether, these characteristics explained more than 30 percent of the variation in mortality risk between dialysis centers, after other factors were taken into account.

Dialysis center characteristics "reflecting a coordinated, multidisciplinary environment" are associated with lower , the results suggest. "Our study could not say for certain whether there is a cause-and-effect relationship between these factors and patient mortality," Spiegel adds. "But it can lay the groundwork for future research in this area as part of broader quality improvement efforts."

This study had some important limitations: it was based on reports by staff members from different dialysis facilities and did not include follow-up to assess patient outcomes over time. "Future research should take our list of potential 'best practices' for dialysis and see if implementing those practices makes a difference," adds Spiegel. "Optimally, this would happen in a randomized controlled trial."

Explore further: Dengue fever strikes models in Japan

More information: The article, entitled "Dialysis Practices That Distinguish Facilities with Below- versus Above-Expected Mortality" is online: doi:10.2215/CJN.01620210

add to favorites email to friend print save as pdf

Related Stories

Before starting dialysis, patients need nephrologist care

Mar 25, 2009

For patients with end-stage renal disease (ESRD), receiving care from a nephrologist in the months before starting dialysis reduces the risk of death during the first year on dialysis, reports a study in the May 2009 issue ...

How will bundling impact dialysis units nationwide?

Oct 30, 2009

The proposed Medicare "bundled" payment system for dialysis is likely to reduce government reimbursements for dialysis units in certain regions of the United States and for some types of facilities, according to research ...

Community poverty impacts pre-dialysis care

Aug 05, 2010

The wealth or poverty of kidney disease patients' communities impacts the quality of care patients receive before starting dialysis, according to a study appearing in an upcoming issue of the Journal of the American Society Ne ...

The cost of improving dialysis care

Nov 02, 2009

Improving survival among dialysis patients may increase treatment costs significantly, according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, ...

Overnight hemodialysis dramatically improves survival

Nov 08, 2008

For hemodialysis patients, undergoing dialysis for eight hours overnight, three times weekly, reduces the risk of death by nearly 80 percent, compared to conventional, four-hour dialysis, according to research being presented ...

Recommended for you

Obama addresses West Africans on facts about Ebola

4 hours ago

President Barack Obama urged West Africans on Tuesday to wear gloves and masks when caring for Ebola patients or burying anyone who died of the disease. He also discouraged the traditional burial practice ...

Gluten-free diet benefits asymptomatic EmA+ adults

4 hours ago

(HealthDay)—Asymptomatic individuals with endomysial antibodies (EmA) benefit from a gluten-free diet (GFD), according to a study published in the September issue of Gastroenterology.

Another US health worker infected with Ebola

4 hours ago

A third American health worker has tested positive for the Ebola virus while working with patients in West Africa, the Christian missionary group SIM said Tuesday.

UN implores all countries to help on Ebola

6 hours ago

The international group Doctor Without Borders warned Tuesday that the world is 'losing the battle' against Ebola, while U.N. officials implored all countries to quickly step up their response by contributing health experts ...

Travel restrictions could worsen Ebola crisis: experts

11 hours ago

Travel restrictions could worsen West Africa's Ebola epidemic, limiting medical and food supplies and keeping out much-needed doctors, virologists said Tuesday as the disease continued its deadly spread.

User comments : 0