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A Randomized Evaluation of Two Health Care Quality Improvement Program (HCQIP) Interventions to Improve the Adequacy of Hemodialysis Care of ESRD Patients: Feedback Alone versus Intensive Intervention

William M. McClellan^*,, Emily Hodgin, Stephen Pastan, Lisa McAdams and Michael Soucie

*Georgia Medical Care Foundation, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Southeastern Kidney Council, ESRD Network 6, Raleigh, North Carolina; Centers for Medicare & Medicaid Services, Dallas, Texas.

Correspondence to Dr. William McClellan, Georgia Medical Care Foundation, 57 Executive Park South, Suite 200, Atlanta, Georgia 30329. Phone: 404-982-7573; Fax: 404-982-7591; E-mail: bmcclell{at}gmcf.org

ABSTRACT. End-stage renal disease (ESRD) Networks are quality improvement organizations that collect, analyze, and report information to clinicians and allied health providers about discrepancies between observed patterns of care of ESRD patients and what has been recommended by clinical practice guidelines. The Networks facilitate response to this information by assisting ESRD treatment centers to develop quality improvement programs to redress inadequate care. The authors evaluated this process of quality improvement by selecting 42 treatment centers in a single ESRD Network with the lowest facility-specific mean urea reduction ratio (URR). The treatment centers were randomly assigned to two intervention strategies: (1) feedback alone; (2) an intensive intervention that included feedback, workshops, distribution of educational materials and clinical practice guidelines, technical assistance with the development of quality improvement plans, and continued monitoring. The intensive intervention had greater improvement in the increased proportions of patients dialyzed with prescribed blood flow (P = 0.02) and documented review of prescription (P = 0.01). Furthermore, the mean center URR increased nearly 3% among intensive intervention centers (from 68.1 to 70.9) but only 0.09% among the feedback centers (68.2 to 69.1) (P = 0.002). Similarly, time on dialysis increased 7.5 min on average among patients in intervention centers but decreased 2 min for patients in comparison centers (P = 0.03). These results demonstrate that Network feedback, coupled with the intensive intervention, resulted in improvement in care that would otherwise not have occurred.

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				M. B. Patwardhan, D. B. Matchar, G. P. Samsa, and W. E. Haley Opportunities for Improving Management of Advanced Chronic Kidney Disease American Journal of Medical Quality, June 1, 2008; 23(3): 184 - 192. [Abstract] [PDF]

				R. T. Boonyasai, D. M. Windish, C. Chakraborti, L. S. Feldman, H. R. Rubin, and E. B. Bass Effectiveness of Teaching Quality Improvement to Clinicians: A Systematic Review JAMA, September 5, 2007; 298(9): 1023 - 1037. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673