Estudio prospectivo multicéntrico de calidad en hemodiálisis / Hemodialysis prospectiva multicentric quality study

En el ámbito médico se destinan muchos recursos a la investigación. Sin embargo, los esfuerzos encaminados a evaluar la eficacia de estrategias útiles para trasladar la evidencia científica disponible a la práctica clínica son relativamente escasos. El presente trabajo pretende estudiar la eficacia de ciertas medidas de gestión clínica (feedback, benchmarking y Planes de Mejora) en el resultado del tratamiento con hemodiálisis mediante un estudio prospectivo realizado en 4 centros de diálisis. Se procedió a la monitorización periódica (cada 6-8 meses) de indicadores de hemodiálisis previamente consensuados, informando de los resultados propios de cada centro (feedback) y de éstos en relación al resto (benchmarking). Se elaboraron Planes de Mejora específicos en función de los resultados. Tras dos años de seguimiento el número total de pacientes incluidos ha sido de 294. Se ha obtenido una mejora estadísticamente significativa de los indicadores: % de pacientes con Hb 5 mg/dl. No ha habido cambios estadísticamente significativos en los indicadores: dosis media de eritropoyetina (EPO), tensión arterial (TA), fósforo plasmático (P), Ca x P, parathormona (PTHi) y distribución de accesos vasculares. Las causas que explican la ausencia de modificación de éstos últimos son diversas: situación de partida adecuada de algunos indicadores (TA y accesos), recursos terapéuticos de limitada eficacia (vitamina D, quelantes y otros), recursos de apoyo insuficientes (unidades de dietética), o la elaboración/implantación incorrecta de Planes de Mejora. En conclusión, los instrumentos de gestión clínica implantados, son eficaces para la mejora de los resultados asistenciales de ciertos aspectos de la hemodiálisis (anemia, dosis de diálisis, nutrición e inflamación), aunque han resultado de nula eficacia para mejorar los resultados del metabolismo calcio-fósforo

In medicine a considerable amount of resources are used in research, but very little attention is paid to ensuring that the findings of research are implemented in routine clinical practice. This prospective study has the aim to evaluate the efficiency of some clinical management strategies (feedback, benchmarking and improving plans) on haemodialysis treatment results in 4 different dialysis centres We collected consensus data related to haemodialysis results every 6-8 months and informed each centre about its own results (feedback) and how these related to the others (benchmarking). We designed improving plans for any bad result detected. By the end of two years of follow up, 294 patients had been included in the study. The results obtained at the end of the study had improved in comparison with those obtained at the beginning (statistically significant) for the following indicators: % of patients with Hb 5 mg/dl. No statistical changes were found in: mean erythropoietin (EPO) doses, blood pressure (BP), phosphorus plasmatic, calcium-phosphorus product, parathormone (PTHi) and vascular access distribution. We explained the absence of any improvement because of adequate start indicators in some areas (BP and vascular access), therapy with limited efficiency (calcitriol, calcium carbonate and others), lack of support resources (dietetic unit) or inadequate design/implementation of improving plans. In conclusion, our intervention illustrates that combined clinical management strategies (feedback, benchmarking and improving plans) are efficiency in improving some areas of haemodialysis treatment (anaemia, dialysis dose, nutrition and inflammation), although it does not improve calcium phosphate metabolism related indicators

[Hemodialysis prospective multicentric quality study]. / Estudio prospectivo multicentrico de calidad en hemodialisis.

In medicine a considerable amount of resources are used in research, but very little attention is paid to ensuring that the findings of research are implemented in routine clinical practice. This prospective study has the aim to evaluate the efficiency of some clinical management strategies (feedback, benchmarking and improving plans) on haemodialysis treatment results in 4 different dialysis centres. We collected consensus data related to haemodialysis results every 6-8 months and informed each centre about its own results (feedback) and how these related to the others(benchmarking). We designed improving plans for any bad result detected. By the end of two years of follow up, 294 patients had been included in the study. The results obtained at the end of the study had improved in comparison with those obtained at the beginning (statistically significant) for the following indicators: % of patients with Hb< 11 g/dl, % patients with Kt/v < 1.2, mean Kt/v, mean albumin, % patients with albumin< 3.5 g/dl y % patients with C reactive protein (CRP) > 5 mg/dl. No statistical changes were found in: mean erythropoietin (EPO) doses, blood pressure (BP), phosphorus plasmatic,calcium-phosphorus product, parathormone (PTHi) and vascular access distribution. We explained the absence of any improvement because of adequate start indicators in some areas (BP and vascular access), therapy with limited efficiency (calcitriol, calcium carbonate and others), lack of support resources (dietetic unit) or inadequate design/implementation of improving plans.In conclusion, our intervention illustrates that combined clinical management strategies(feedback, benchmarking and improving plans) are efficiency in improving some areas of haemodialysis treatment (anaemia, dialysis dose, nutrition and inflammation), although it does not improve calcium phosphate metabolism related indicators.