Economic Impact of a Peritoneal Dialysis Continuous Quality Improvement Program in Colombia

Makhija, Dilip; Walton, Surrey M.; Mora, Juan Pablo; Sanabria, Rafael M

doi:10.3747/pdi.2016.00111

Cited by 15 publications

(9 citation statements)

References 15 publications

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“…Following these initiatives, peritonitis rates decreased by approximately one third, and between-centre variations in peritonitis rates decreased by 50%. These findings were supported by those of a PD CQI programme in Colombia [20] in which introducing six key programme elements (improved PD nurse:patient ratios, the use of an exit-site care protocol, standardisation of PD guidelines and protocols, nurse certification and continuing education, home visits and systematic follow-up and actioning clinic results) resulted in a reduction in peritonitis rates from 0.57 episodes per patient-year in 2006 to 0.20 episodes per patient-year in 2014. Similar improvements in PD peritonitis rates at the individual centre level have been reported by Yu et al in China [21] and Qamar et al in the United States [22].…”

Section: Evidence That Modifying Centre Practices Leads To Better Persupporting

confidence: 78%

“…Continuous quality improvement programmes have been shown to be associated with improved peritonitis outcomes at national levels [19,20]. Strong evidence for this can be seen in the Australian and New Zealand approach, as reported by Nataatmadja et al [19], which was characterised by the creation of a national peritonitis registry to monitor peritonitis incidence and identify risk factors for peritonitis (ANZDATA) and a commitment to ongoing cycles of data analysis and feedback to PD centres with a national PD peritonitis key performance indicator (KPI) project.…”

Section: Evidence That Modifying Centre Practices Leads To Better Permentioning

confidence: 99%

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Centre Effects in Peritoneal Dialysis

Ng¹,

Cho²,

Htay³

et al. 2018

Evolving Strategies in Peritoneal Dialysis

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Peritoneal dialysis (PD)-related complications and outcomes have been shown to be influenced by both patient-and centre-level factors. There is a significant variability in outcomes across different centres, which is not explained by patient factors alone. This chapter aims to evaluate those modifiable centre-level factors that have been shown to impact PD outcomes, focussing specifically on peritonitis and technique failure, and the evidence that addressing these centre effects may lead to appreciable improvements in PD patient outcomes. Peritonitis rates have been shown to be related to a centre's degree of automated PD (APD) use, extent of icodextrin use, performance of home visits prior to PD commencement, the presence of a specialised PD nurse and duration of PD training. Better peritonitis outcomes have been shown to be associated with larger centre size, greater share of PD patients among dialysis cohorts and treatment of peritonitis with comprehensive empiric antimicrobial therapy. PD technique failure has been shown to be related to centre size and degree of PD experience. Although there is little evidence currently available to demonstrate that prospectively modifying centre factors improves PD outcomes, an Australian continuous quality improvement initiative has been associated with progressively improved peritonitis and technique failure outcomes.

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Section: Evidence That Modifying Centre Practices Leads To Better Persupporting

confidence: 78%

Section: Evidence That Modifying Centre Practices Leads To Better Permentioning

confidence: 99%

Centre Effects in Peritoneal Dialysis

Ng¹,

Cho²,

Htay³

et al. 2018

Evolving Strategies in Peritoneal Dialysis

View full text Add to dashboard Cite

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“…The cost of outpatient treatment of peritonitis was based on a recent estimate in the literature. 14 Costs associated with switching of dialysis modality due to APD technique failure were estimated internally based on published costs of associated medical and surgical procedures in Colombia. 11,12 Specifically, APD technique failure was assumed to include the cost of switching the patient to hemodialysis, which involves the insertion of a temporary central venous catheter, an arteriovenous fistula surgical procedure, and the need for professional services to support patients switching therapy.…”

Section: Methodsmentioning

confidence: 99%

Evaluating a remote patient monitoring program for automated peritoneal dialysis

et al. 2020

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Background: The benefits of automated peritoneal dialysis (APD) have been established, but patient adherence to treatment remains a concern. Remote patient monitoring (RPM) programs are a potential solution; however, the cost implications are not well established. This study modeled, from the payer perspective, expected net costs and clinical consequences of a novel RPM program in Colombia. Methods: Amarkov model was used to project costs and clinical outcomes for APD patients with and without RPM. Clinical inputs were directly estimated from Renal Care Services data or taken from the literature. Dialysis costs were estimated from national fees. Inpatient costs were obtained from a recent Colombian study. The model projected overall direct costs and several clinical outcomes. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were also conducted to characterize uncertainty in the results. Results: The model projected that the implementation of an RPM program costing US$35 per month in a cohort of 100 APD patients over 1 year would save US$121,233. The model also projected 31 additional months free of complications, 27 fewer hospitalizations, 518 fewer hospitalization days, and 6 fewer peritonitis episodes. In the DSA, results were most sensitive to hospitalization rates and days of hospitalization, but cost savings were robust. The PSA found there was a 91% chance for the RPM program to be cost saving. Conclusion: The results of the model suggest that RPM is cost-effective in APD patients which should be verified by a rigorous prospective cost analysis.

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“…Among these, 351 articles were excluded after title screening and the abstract of the 784 remaining papers was assessed. Finally, 461 publications were excluded following the eligibility criteria and thus, 323 articles that had interpretable data and fulfilled the eligibility criteria were used for data extraction…”

Section: Resultsmentioning

confidence: 99%