Lacson Eduardo, Xu Jianglin, Lin Shu-Fang, Dean Sandie Guerra, Lazarus J Michael, Hakim Raymond
Clinical Sciences, Epidemiology, and Research, Fresenius Medical Care North America, Waltham, MA 02451-1457, USA.
Am J Kidney Dis. 2009 Dec;54(6):1098-107. doi: 10.1053/j.ajkd.2009.07.017. Epub 2009 Sep 25.
Incremental achievement of quality indicator goals has been associated with progressive improvement in mortality and hospitalization risk in hemodialysis (HD) patients.
Descriptive cross-sectional study.
SETTING & PARTICIPANTS: All 33,879 HD patients treated at Fresenius Medical Care North America facilities for >90 days with scorable 36-Item Short Form Health Survey responses from January 1, 2006, to December 31, 2006.
We hypothesized that achieving up to 5 HD goals before the survey (albumin >or= 4.0 g/dL, hemoglobin of 11-12 g/dL, equilibrated Kt/V >or= 1.2, phosphorus of 3.5-5.5 mg/L, and absence of HD catheter) results in better self-reported quality of life (QoL).
OUTCOMES & MEASUREMENTS: Distributions of Physical and Mental Component Summary (PCS/MCS) scores within and across quality indicator categories determined during the prior 90 days from survey date (compared using analysis of covariance and linear regression models, with adjustment for case-mix and each of the quality indicators).
Incremental achievement of up to 5 goals was associated with progressively higher PCS and MCS scores (both P for trend < 0.001). Compared with patients meeting all 5 goals (n = 4,208; reference group), case-mix-adjusted PCS score was lower by 1.8 point with only 4 goals met (n = 11,785), 3.4 points for 3 goals (n = 10,906), 4.9 points for 2 goals (n = 5,119), 5.9 points for 1 goal (n = 1,592), and 7.8 points in the 269 patients who failed to meet any goal (each P < 0.001 vs the reference group). The corresponding decreases in case-mix-adjusted MCS scores were 1.0 point for 4 goals met, 1.7 point for 3 goals, 2.3 points for 2 goals, 3.0 points for 1 goal, and 4.7 points with no goal met, with each P < 0.001 compared with the MCS score from patients who achieved all 5 goals.
Potential residual confounding from unmeasured covariates.
Patients progressively meeting more quality goals report incrementally better QoL. Further studies are needed to determine whether prospective achievement of quality goals will result in improved QoL for HD patients.
在血液透析（HD）患者中，质量指标目标的逐步实现与死亡率和住院风险的逐步改善相关。
描述性横断面研究。
2006年1月1日至2006年12月31日期间，在北美费森尤斯医疗护理机构接受治疗超过90天且36项简明健康调查问卷回答可评分的所有33879例HD患者。
我们假设在调查前实现多达5项HD目标（白蛋白≥4.0g/dL、血红蛋白11 - 12g/dL、平衡Kt/V≥1.2、磷3.5 - 5.5mg/L以及无HD导管）可带来更好的自我报告生活质量（QoL）。
在调查日期前90天内确定的质量指标类别内和类别间，身体和心理综合得分（PCS/MCS）的分布情况（使用协方差分析和线性回归模型进行比较，并对病例组合和每个质量指标进行调整）。
多达5项目标的逐步实现与PCS和MCS得分逐步升高相关（趋势P值均<0.001）。与实现所有5项目标的患者（n = 4208；参照组）相比，病例组合调整后的PCS得分在仅实现4项目标时（n = 11785）低1.8分，实现3项目标时（n = 10906）低3.4分，实现2项目标时（n = 5119）低4.9分，实现1项目标时（n = 1592）低5.9分，在未实现任何目标的269例患者中低7.8分（与参照组相比，各P值<0.001）。病例组合调整后的MCS得分相应下降情况为，实现4项目标时低1.0分，实现3项目标时低1.7分，实现2项目标时低2.3分，实现1项目标时低3.0分，未实现任何目标时低4.7分，与实现所有5项目标的患者的MCS得分相比，各P值<0.001。
未测量的协变量可能存在潜在的残余混杂因素。
逐步实现更多质量目标的患者报告的生活质量逐步更好。需要进一步研究以确定前瞻性实现质量目标是否会改善HD患者的生活质量。
