Clinical Pathways and Outcome Evaluation Unit, Fondazione Policlinico Universitario A.Gemelli IRCSS, Rome, Italy.
Società Italiana di Ginecologia e Ostetricia, Rome, Italy.
BMC Health Serv Res. 2023 Feb 23;23(1):192. doi: 10.1186/s12913-023-09183-3.
Rising incidence and prevalence of end-stage renal disease is a worldwide concern for sustainability of healthcare systems and societies. Living donor renal transplant [LDRT] provides highest health achievements and cost containment than any alternative form of renal replacement therapy. Nonetheless, about 25% of potential LDRTs are missed for causes directly related with inadequate timing in donor assessment. Our quality improvement (QI) project implement process control tools and strategy aiming at reducing total evaluation time for donor candidates and minimizing dialysis exposure for intended recipients, which are the two main determinants of clinical outcomes and costs.
The study includes patients who underwent donor nephrectomy between January 1, 2017 and December 31, 2021. Six Sigma DMAIC approach was adopted to assess Base Case performance (Jan2017-Jun2019) and to design and implement our QI project. Study of current state analysis focused on distribution of time intervals within the assessment process, analysis of roles and impacts of involved healthcare providers and identification of targets of improvement. Improved Scenario (Jul2019-Dec2021) was assessed in terms of total lead time reduction, total pre-transplantation dialysis exposure and costs reduction, and increase in pre-emptive transplantations. The study was reported following SQUIRE 2.0 Guidelines for QI projects.
Study population includes 63 patients, 37 in Base Case and 26 in Improved Scenario. Total lead time reduced from a median of 293 to 166 days and this in turn reduced pre-transplantation dialysis exposure and costs by 45%. Rate of potential pre-emptive donors' loss changes from 44% to 27%.
Lean methodology is an effective tool to improve quality and efficiency of healthcare processes, in the interest of patients, healthcare professionals and payers.
终末期肾病的发病率和患病率不断上升，这是全球医疗保健系统和社会可持续性面临的一个关注问题。活体供肾肾移植 [LDRT] 比任何其他形式的肾脏替代疗法都能提供更高的健康效益和成本控制。尽管如此，大约 25%的潜在 LDRT 由于与供体评估时机不当直接相关的原因而被错过。我们的质量改进 (QI) 项目实施过程控制工具和策略，旨在减少供体候选人的总评估时间，并最大限度地减少预期受者的透析暴露，这是临床结果和成本的两个主要决定因素。
本研究纳入了 2017 年 1 月 1 日至 2021 年 12 月 31 日期间接受供体肾切除术的患者。采用六西格玛 DMAIC 方法评估基线情况（2017 年 1 月至 2019 年 6 月），并设计和实施我们的 QI 项目。现状研究侧重于评估过程中时间间隔的分布，分析参与医疗保健提供者的角色和影响，以及确定改进的目标。在总前置时间减少、总术前透析暴露和成本减少以及预防性移植增加方面，评估了改进方案（2019 年 7 月至 2021 年 12 月）。本研究按照 SQUIRE 2.0 质量改进项目指南进行报告。
研究人群包括 63 名患者，37 名在基线组，26 名在改进组。总前置时间从中位数 293 天减少到 166 天，这反过来又使术前透析暴露和成本减少了 45%。潜在预防性供体流失率从 44%下降到 27%。
精益方法是一种有效的工具，可以提高医疗保健流程的质量和效率，符合患者、医疗保健专业人员和支付者的利益。
