Gehr Todd, Bender Filitsa, Fink Jeffrey, Light Paul, Elliott Karen, Shield Christie, Turner Mary, Mays Cathy, Parrish Joan, Armistead Nancy
Virginia Commonwealth University, Richmond, Virginia, USA.
Adv Perit Dial. 2003;19:86-92.
The goal of the quality improvement project reported here was to increase the proportion of peritoneal dialysis (PD) patients receiving adequate dialysis as defined by the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines. Our approach was to increase the frequency with which we measured PD adequacy and changed prescriptions in response to low adequacy values. We developed 3 indicators, each one subdivided to reflect differences by type of PD and time on PD. Our improvement goal was to achieve the midpoint between baseline performance on those indicators and 100%, equating to a 50% reduction in failure rate (RFR). At baseline, the project included 122 facilities with 1,517 patients (data from October 1999 to March 2000). At re-measurement, we had 117 facilities with 1,372 patients (data from January 2001 to June 2001). In addition to obtaining facility-specific feedback reports, we conducted educational intervention workshops to which all PD providers were invited. After the workshops, "mandatory intervention" facilities submitted improvement plans that were reviewed by the PD Adequacy Work Group to determine if improvement actions were appropriately focused on identified root causes. Not all intervention facilities attended the workshops, and some facilities attended voluntarily. Overall, the Network 5 results showed a statistically significant improvement in measuring PD adequacy (84% baseline to 92% re-measurement), with a corresponding 51% RFR. Improvement in desired levels of adequacy was also statistically significant (55% baseline to 64% re-measurement), with a 21% RFR. Analysis by the intervention group showed that "mandatory intervention" facilities improved more than did "voluntary" facilities in measuring adequacy and in reaching desired levels, and that the differences were statistically significant. Quality improvement efforts that focused on improving the adequacy of PD in Network 5 were accomplished.
此处报告的质量改进项目的目标是，提高接受充分透析的腹膜透析（PD）患者的比例，充分透析的定义依据美国国家肾脏基金会透析预后质量倡议（NKF - DOQI）指南。我们的方法是增加测量PD充分性的频率，并根据低充分性值更改处方。我们制定了3项指标，每项指标再细分以反映不同类型的PD以及PD治疗时间的差异。我们的改进目标是达到这些指标基线表现与100%之间的中点，相当于将失败率（RFR）降低50%。基线时，该项目包括122个机构的1517名患者（数据来自1999年10月至2000年3月）。重新测量时，我们有117个机构的1372名患者（数据来自2001年1月至2001年6月）。除了获取各机构的反馈报告外，我们还举办了教育干预研讨会，并邀请了所有PD治疗人员参加。研讨会结束后，“强制干预”机构提交了改进计划，由PD充分性工作组进行审查，以确定改进措施是否恰当地聚焦于已确定的根本原因。并非所有干预机构都参加了研讨会，有些机构是自愿参加的。总体而言，第5网络的结果显示，在测量PD充分性方面有统计学意义的改善（基线时为84%，重新测量时为92%），相应的RFR为51%。在达到期望的充分性水平方面也有统计学意义的改善（基线时为55%，重新测量时为64%），RFR为21%。干预组的分析表明，“强制干预”机构在测量充分性和达到期望水平方面比“自愿”机构改善得更多，且差异具有统计学意义。聚焦于提高第5网络中PD充分性的质量改进工作取得了成效。
