CITATION:
Mendelssohn DC, Pisoni RL, Arrington CJ, Yeates KE, Leblanc M, Deziel C, Akiba T, Krishnan M, Fukuhara S, Lameire N, Port FK, Wolfe RA. A practice-related risk score (PRS): a DOPPS-derived aggregate quality index for haemodialysis facilities. Nephrol Dial Transplant 2008; 23(10): 3227-3233
ABSTRACT:
BACKGROUND: The Dialysis Outcomes and Practice Patterns Study (DOPPS) database was used to develop and validate a practice-related risk score (PRS) based on modifiable practices to help facilities assess potential areas for improving patient care. METHODS: Relative risks (RRs) from a multivariable Cox mortality model, based on observational haemodialysis (HD) patient data from DOPPS I (1996-2001, seven countries), were used. The four practices were the percent of patients with Kt/V > or =1.2, haemoglobin > or =11 g/dl (110 g/l), albumin > or =4.0 g/dl (40g/l) and catheter use, and were significantly related to mortality when modelled together. DOPPS II data (2002-2004, 12 countries) were used to evaluate the relationship between PRS and mortality risk using Cox regression. RESULTS: For facilities in DOPPS I and II, changes in PRS over time were significantly correlated with changes in the standardized mortality ratio (SMR). The PRS ranged from 1.0 to 2.1. Overall, the adjusted RR of death was 1.05 per 0.1 points higher PRS (P < 0.0001). For facilities in both DOPPS I and II (N = 119), a 0.2 decrease in PRS was associated with a 0.19 decrease in SMR (P = 0.005). On average, facilities that improved PRS practices showed significantly reduced mortality over the same time frame. CONCLUSIONS: The PRS assesses modifiable HD practices that are linked to improved patient survival. Further refinements might lead to improvements in the PRS and will address regional variations in the PRS/mortality relationship.
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The DOPPS Annual Report
The DOPPS Annual Report portrays descriptive statistics for multiple, representative cross-sectional cohorts over several practice areas, from anemia to vascular access.
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DOPPS Presentations of Published Research
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Coordinated by research scientists
and staff of Arbor Research Collaborative
for Health, and supported by research grants from Amgen (since 1996),
Kyowa Hakko Kirin (since 1999, in Japan), Genzyme (since 2009), and Abbott (since 2009) without
restrictions on publications.
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