Improving the Management of Anemia in Hemodialysis Patients by Implementing the Continuous Quality Improvement Program

Chen, Min; Deng, Jinhua; Zhou, Fu-de; Wang, Mei; Wang, Haiyan

doi:10.1159/000091304

Cited by 8 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study showed that patients in the low-frequency PPC group had significantly lower mean levels of Hb and higher levels of P. Anemia therapy is a continuous quality improvement process that involves careful adjustment of the doses of iron and erythropoietin according to iron deficiency status (20). It is reasonable to observe worse anemia control in patients with less clinic PPC.…”

Section: Discussionmentioning

confidence: 64%

Is Frequency of Patient–Physician Clinic Contact Important in Peritoneal Dialysis Patients?

2009

View full text Add to dashboard Cite

Objective In a single-center retrospective cohort study, we investigated whether the frequency of clinic patient–physician contact (PPC) correlates with quality of care and can predict outcome in peritoneal dialysis (PD) patients. Patients and Methods We enrolled 307 incident PD patients who started PD from July 2002 to February 2007. All patients who visited the clinic at least once every 6 months and who lived for at least 6 months were followed until death, transfer to hemodialysis, renal transplantation, or February 2008 (censor date). Throughout the study period, an integrative follow-up strategy was used, including PPC and three other modes of contact between patients and non-physicians. Patients’ PPC frequency was divided into 3 categories: high frequency (monthly or more often), intermediate frequency (every 1 – 3 months), and low frequency (every 3 – 6 months). Baseline demographic and biochemical data were collected. Indices of diet, dialysis adequacy, biochemistry, and nutrition were measured at every visit and then calculated as mean values. Results We followed the 307 patients for a mean of 31.45 ± 13.62 months (range: 12 – 64 months). By PPC frequency, 127 patients (41.3%) were in the high-frequency group; 136 (44.3%), in the intermediate-frequency group; and 44 (14.3%), in the low-frequency group. We observed no difference of baseline demographic and biochemical data between the three groups ( p > 0.05). Patients in the low-frequency group had lower mean hemoglobin and total urea clearance rates, but higher serum phosphate than did patients in the intermediate- or high-frequency groups ( p < 0.05). Mean indices of nutrition, including serum albumin, daily protein and energy intake, and lean body mass were not different between the three groups ( p > 0.05). Frequency of PPC did not show an effect on the survival of PD patients ( p = 0.37 by Kaplan–Meier plot). Age ( p = 0.002), Charlson comorbidity score ( p = 0.001), and pre-dialysis albumin ( p = 0.019) were independent negative risk factors for death in multivariate Cox proportional hazard models, which were adjusted for sex, PPC frequency, baseline hemoglobin, and glomerular filtration rate. Conclusions Frequency of PPC did not predict outcome in PD patients after an integrative care strategy was implemented. Control of anemia and hyperphosphatemia needs to be strengthened in patients with a low frequency of PPC.

show abstract

Section: Discussionmentioning

confidence: 64%

Is Frequency of Patient–Physician Clinic Contact Important in Peritoneal Dialysis Patients?

2009

View full text Add to dashboard Cite

show abstract

“…The Plan-Do-Study/Check-Act cycle is a stepwise process involving project initiation, situation analysis, root cause identification, solution generation and selection, implementation, result evaluation, standardization, and future planning [7, 36, 37, 45, 47-51, 53, 56-70]. The FOCUS-PDCA cycle enhances the PDCA process by adding steps to find and improve a process (F), organize a knowledgeable team (O), clarify the process (C), understand variations (U), and select improvements (S) [55,[71][72][73]. The FADE cycle involves identifying a problem (Focus), understanding it through data analysis (Analyze), devising solutions (Develop), and implementing the plan (Execute) [74].…”

Section: Continuous Quality Improvement Models and Toolsmentioning

confidence: 99%

“…Immunization program [44], maternal and child health [76], and healthcare financing [73] PDCA Flowcharts Healthcare costs [73], frequency of episiotomy procedures [74], and immunization rate [72] Lean Six Sigma, FOCUS-PDCA cycle, Meeting…”

Section: Checklistmentioning

confidence: 99%

See 1 more Smart Citation

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

Endalamaw,

Khatri,

Mengistu

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

Background The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts. Methods This qualitative scoping review was conducted using Arksey and O’Malley’s methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works. Results A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI. Conclusions Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it’s crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.

show abstract

“…A study found a short-term association between Hb levels and hospitalization rates. The long-term effects of Hb levels on patient mortality and morbidity require more investigation [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

Shortcoming of Measuring Patient Satisfaction’s Association With Anemia-Based Cardiovascular Risk in End-Stage Kidney Disease Patients

et al. 2021

View full text Add to dashboard Cite

Background Patient-reported humanistic outcomes like patient satisfaction are becoming more important in clinical practice, but their use has limitations. Improvements are needed to better demonstrate how patient satisfaction and clinical outcomes are associated. The objective of the study was to observe the correlation between patient’s hemoglobin and patient satisfaction. Methods A cross-sectional study was conducted at a University Hospital hemodialysis unit among end-stage kidney disease (ESKD) patients on maintenance hemodialysis in February and March, 2021. During this time period patient satisfaction was measured using an instrument from the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study. Spearman’s correlation coefficient was used to find a correlation between patient satisfaction domains and hemoglobin. P value was set at 0.05, and SPSS version 26 was used for the analysis. Results Out of 41 patients studied, their satisfaction on care by interprofessional staff was 77.3%, information received was 68.8%, and effectiveness of care was 71.3% for “very good” and “excellent” responses combined. Out of 40 patients, hemoglobin levels were lower in 17 (42.5%) and higher in seven (17.5%) patients than the optimal range of 10 - 12 g/dL. Spearman’s correlation coefficients were not statistically significant for anemia and any patient satisfaction domain (r s : 0.244, 0.101, 0.048, respectively for the three domains). Spearman’s correlation coefficients were high or moderate between patient satisfaction domains; interprofessional staff with information (r s : 0.745, P value < 0.001) and interprofessional staff with the effectiveness of care (r s : 0.619, P value < 0.001). Information domain had a moderate correlation with the effectiveness of care (r s : 0.527, P value < 0.001). Conclusions No correlation was observed between patient satisfaction with hemoglobin. Although patient satisfaction among hemodialysis patients was mostly “very good” or “excellent”, nearly half of the patients were anemic, and some had higher hemoglobin than the target. Since both of these groups have higher cardiovascular risk this provides an opportunity for the development of patient satisfaction tools with greater sensitivity to awareness of patients’ cardiovascular risk.

show abstract

Improving the Management of Anemia in Hemodialysis Patients by Implementing the Continuous Quality Improvement Program

Cited by 8 publications

References 19 publications

Is Frequency of Patient–Physician Clinic Contact Important in Peritoneal Dialysis Patients?

Is Frequency of Patient–Physician Clinic Contact Important in Peritoneal Dialysis Patients?

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

Shortcoming of Measuring Patient Satisfaction’s Association With Anemia-Based Cardiovascular Risk in End-Stage Kidney Disease Patients

Contact Info

Product

Resources

About