Going beyond the kidney disease outcomes quality initiative: Hemodialysis access experience at kaiser permanente southern california

被引:19
作者
Glazer, S
Diesto, J
Crooks, P
Yeoh, H
Pascual, N
Selevan, D
Derose, S
Farooq, M
机构
[1] So Calif Permanente Med Grp, Dept Surg, Anaheim, CA USA
[2] So Calif Permanente Med Grp, Renal Program Adm, Pasadena, CA USA
[3] So Calif Permanente Med Grp, Dept Nephrol, Los Angeles, CA 90027 USA
[4] Kaiser Permanente So Calif, Dept Res & Evaluat, Pasadena, CA USA
关键词
D O I
10.1007/s10016-005-9110-8
中图分类号
R61 [外科手术学];
学科分类号
摘要
In 1996, as part of Kaiser Permanente Southern California's participation in the Medicare End-Stage Renal Disease Managed Care Demonstration Project, a multidisciplinary continuous quality improvement (CQI) committee was formed, which included nephrologists, vascular surgeons, interventional radiologists, care managers, a renal quality-improvement nursing director, and renal program administrators. The goal of this report was to analyze the impact of this CQI program on hemodialysis outcomes within the organization. Kaiser Permanente is a national, integrated, nonprofit, staff model health maintenance organization with 8 million members. The southern California region has 3.1 million members and currently manages the health care of 3,700 hemodialysis patients, 300 peritoneal dialysis patients, and 1,000 kidney transplant patients. Thirty-one vascular surgeons and 29 interventional radiologists provide for their hemodialysis access needs. The Kidney Disease Dialysis Outcomes Quality Initiative (K/DOQI) guidelines were adopted, as well as measures to perform more venous transpositions and less common arteriovenous fistulas (AVFs) before graft placement. The outcomes assessed included incidence and prevalence of AVFs, grafts, and catheters; replacement access with AVFs; and combined AVF and graft thrombosis episodes per patient per year. Primary AVF incidence rates increased from 27% in 1997 to 88% in 2003. AVF prevalence rates increased from 30% in 1997 to 62% in 2003. Replacement access which is an AVF increased from 26% in 1998 to 58% in 2003. Yearly thrombosis episodes/patient decreased from 0.62 in 1998 to 0.34 in 2003. Catheter usage as of 2003 comprised an incidence of 65% and prevalence (>= 90 days) of 13%, which was essentially unchanged from 1999, despite improvements in fistula usage and thrombosis rate. The rate of AVF prevalence can be increased dramatically, exceeding the 40% K/DOQI recommendation, by using the CQI process. Increased prevalence of AVF is associated with a lower yearly incidence of thrombosis episodes/patient. Reducing excessive catheter usage appears to be a more difficult problem.
引用
收藏
页码:75 / 82
页数:8
相关论文
共 28 条
  • [1] [Anonymous], 2001, Am J Kidney Dis, DOI DOI 10.1016/S0272-6386(01)70007-8
  • [2] An algorithm for the physical examination of early fistula failure
    Beathard, GA
    [J]. SEMINARS IN DIALYSIS, 2005, 18 (04) : 331 - 335
  • [3] Aggressive treatment of early fistula failure
    Beathard, GA
    Arnold, P
    Jackson, J
    Litchfield, T
    [J]. KIDNEY INTERNATIONAL, 2003, 64 (04) : 1487 - 1494
  • [4] Physical examination of the dialysis vascular access
    Beathard, GA
    [J]. SEMINARS IN DIALYSIS, 1998, 11 (04) : 231 - 236
  • [5] Preventing vascular access dysfunction: Which policy to follow
    Besarab, A
    [J]. BLOOD PURIFICATION, 2002, 20 (01) : 26 - 35
  • [6] CHRONIC HEMODIALYSIS USING VENIPUNCTURE AND A SURGICALLY CREATED ARTERIOVENOUS FISTULA
    BRESCIA, MJ
    CIMINO, JE
    APPEL, K
    HURWICH, BJ
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1966, 275 (20) : 1089 - &
  • [7] Funaki Brian, 2004, Semin Intervent Radiol, V21, P111, DOI 10.1055/s-2004-833684
  • [8] Glazer S, 2000, Nephrol News Issues, V14, P21
  • [9] Longitudinal comparison of dialysis access methods: Risk factors for failure
    Hodges, TC
    Fillinger, MF
    Zwolak, RM
    Walsh, DB
    Bech, F
    Cronenwett, JL
    [J]. JOURNAL OF VASCULAR SURGERY, 1997, 26 (06) : 1009 - 1019
  • [10] Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty
    Liang, HL
    Pan, HB
    Chung, HM
    Ger, LP
    Fang, HC
    Wu, TH
    Wu, MT
    Lai, PH
    Chen, CKH
    Yang, CF
    [J]. RADIOLOGY, 2002, 223 (02) : 339 - 344