Toussaint Nigel D, McMahon Lawrence P, Dowling Gregory, Holt Stephen G, Smith Gillian, Safe Maria, Knight Richard, Fair Kathleen, Linehan Leanne, Walker Rowan G, Power David A
Department of Nephrology, The Royal Melbourne Hospital, Parkville, VIC, Australia
Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
Perit Dial Int. 2017 Mar-Apr;37(2):198-204. doi: 10.3747/pdi.2016.00149. Epub 2016 Sep 28.
♦ BACKGROUND: Increased demand for treatment of end-stage kidney disease has largely been accommodated by a costly increase in satellite hemodialysis (SHD) in most jurisdictions. In the Australian State of Victoria, a marked regional variation in the uptake of home-based dialysis suggests that use of home therapies could be increased as an alternative to SHD. An earlier strategy based solely on increased remuneration had failed to increase uptake of home therapies. Therefore, the public dialysis funder adopted the incidence and prevalence of home-based dialysis therapies as a key performance indicator (KPI) for its health services to encourage greater uptake of home therapies. ♦ METHODS: A KPI data collection and bench-marking program was established in 2012 by the Victorian Department of Health and Human Services, with data provided monthly by all renal units in Victoria using a purpose-designed website portal. A KPI Working Group was responsible for analyzing data each quarter and ensuring indicators remained accurate and relevant and each KPI had clear definitions and targets. We present a prospective, observational study of all dialysis patients in Victoria over a 4-year period following the introduction of the renal KPI program, with descriptive analyses to evaluate the proportion of patients using home therapies as well as home dialysis modality survival. ♦ RESULTS: Following the introduction of the KPI program, the net growth of dialysis patient numbers in Victoria remained stable over 4 years, at 75 - 80 per year (approximately 4%). However, unlike the previous decade, about 40% of this growth was through an increase in home dialysis, which was almost exclusively peritoneal dialysis (PD). The increase was identified particularly in the young (20 - 49) and the elderly (> 80). Disappointingly, however, 67% of these incident patients ceased PD within 2 years of commencement, 46% of whom transferred to SHD. ♦ CONCLUSIONS: Introduction of a KPI program was associated with an increased uptake of PD but not home HD. This change in clinical practice restricted growth of SHD and reduced pressure on satellite services. The effect was offset by a modest PD technique survival. Many patients in whom PD was unsuccessful were subsequently transferred to SHD rather than home HD.
♦ 背景：在大多数司法管辖区，终末期肾病治疗需求的增加很大程度上通过卫星血液透析（SHD）成本高昂的增加得到了满足。在澳大利亚维多利亚州，家庭透析使用情况存在显著的地区差异，这表明家庭治疗作为SHD的替代方案，其使用量可以增加。早期仅基于提高薪酬的策略未能增加家庭治疗的使用量。因此，公共透析资助者将家庭透析治疗的发病率和患病率作为其卫生服务的关键绩效指标（KPI），以鼓励更多地采用家庭治疗。♦ 方法：2012年，维多利亚州卫生与公众服务部建立了一个KPI数据收集和基准项目，维多利亚州所有肾脏单位每月通过一个专门设计的网站门户提供数据。一个KPI工作组负责每季度分析数据，并确保指标保持准确和相关，每个KPI都有明确的定义和目标。我们对肾脏KPI项目引入后4年期间维多利亚州所有透析患者进行了一项前瞻性观察研究，进行描述性分析以评估使用家庭治疗的患者比例以及家庭透析方式的生存率。♦ 结果：引入KPI项目后，维多利亚州透析患者数量的净增长在4年内保持稳定，每年75 - 80人（约4%）。然而，与前十年不同的是，这种增长的约40%是通过家庭透析的增加实现的，几乎全部是腹膜透析（PD）。这种增长在年轻人（20 - 49岁）和老年人（> 80岁）中尤为明显。然而，令人失望的是，这些新发病例中有67%在开始治疗后的2年内停止了PD，其中46%转而接受SHD。♦ 结论：KPI项目的引入与PD使用量的增加相关，但与家庭血液透析（HD）无关。这种临床实践的变化限制了SHD的增长，并减轻了卫星服务的压力。这一效果被适度的PD技术生存率所抵消。许多PD治疗不成功的患者随后转而接受SHD，而不是家庭HD。
