Prolonged patient survival after implementation of a continuous quality improvement programme empowered by digital transformation in a large dialysis network

Abstract

Background Treatment of end-stage kidney disease patients is extremely challenging given the interconnected functional derangements and comorbidities characterizing the disease. Continuous quality improvement (CQI) in healthcare is a structured clinical governance process helping physicians adhere to best clinical practices. The digitization of patient medical records and data warehousing technologies has standardized and enhanced the efficiency of the CQI’s evidence generation process. There is limited evidence that ameliorating intermediate outcomes would translate into better patient-centred outcomes. We sought to evaluate the relationship between Fresenius Medical Care medical patient review CQI (MPR-CQI) implementation and patients’ survival in a large historical cohort study. Methods We included all incident adult patients with 6-months survival on chronic dialysis registered in the Europe, Middle East and Africa region between 2011 and 2018. We compared medical key performance indicator (KPI) target achievements and 2-year mortality for patients enrolled prior to and after MPR-CQI policy onset (Cohorts A and B). We adopted a structural equation model where MPR-CQI policy was the exogenous explanatory variable, KPI target achievements was the mediator variable and survival was the outcome of interest. Results About 4270 patients (Cohort A: 2397; Cohort B: 1873) met the inclusion criteria. We observed an increase in KPI target achievements after MPR-CQI policy implementation. Mediation analysis demonstrated a significant reduction in mortality due to an indirect effect of MPR-CQI implementation through improvement in KPI target achievement occurring in the post-implementation era [odds ratio 0.70 (95% confidence interval 0.65–0.76); P < 0.0001]. Conclusions Our study suggests that MPR-CQI achieved by standardized clinical practice and periodic structured MPR may improve patients’ survival through improvement in medical KPIs.

Effect of Dialysate and Plasma Sodium on Mortality in a Global Historical Hemodialysis Cohort

“…4,17 The database contains patient characteristics, daily HD treatment data based on the values set on the machine for each session, laboratory parameters, and medications. 17 The data quality of the analysis set (01-2010 to 12-2019) is validated by the continuous quality improvement program FMC initiated in 2007. 18 Monthly review of key performance indicators enables data driven, objective, and continuous monitoring of clinical and operational performances across all countries.…”

“…18 Monthly review of key performance indicators enables data driven, objective, and continuous monitoring of clinical and operational performances across all countries. 18 These governance processes ensure that clinical care is driven by improvements in key performance indicators. 18 This means that the quality of therapy is not customized according to insurance or reimbursement rate.…”

“…18 These governance processes ensure that clinical care is driven by improvements in key performance indicators. 18 This means that the quality of therapy is not customized according to insurance or reimbursement rate. 18 Ethical approval was granted by the Ethics Committee of Wuerzburg University Hospital (Reference No.…”

“…18 This means that the quality of therapy is not customized according to insurance or reimbursement rate. 18 Ethical approval was granted by the Ethics Committee of Wuerzburg University Hospital (Reference No. 255/22).…”

War in Ukraine and dialysis treatment: human suffering and organizational challenges

“…[ 15 ]. Since June we have progressively recovered our dialysis quality standards [ 16 ] in accordance with the FME Europe, Middle East and Africa (EMEA) medical continuous quality performance guidelines [ 16 ], and in July, August and September both dialysis and medical quality key performance indicators, respectively, were equal, if not superior to those evaluated in January, before the start of the war (Table 1 ).…”