Implementation of renal key performance indicators: Promoting improved clinical practice

Toussaint, Nigel D; McMahon, Lawrence P.; Dowling, Gregory; Soding, Jenny; Safe, Maria; Knight, Richard J.; Fair, Kathleen; Linehan, Leanne; Walker, Rowan G.; Power, David A.

doi:10.1111/nep.12366

Cited by 24 publications

(36 citation statements)

References 23 publications

(35 reference statements)

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“…5 Preemptive living kidney donor transplantation is promoted as the preferred initial renal replacement therapy (RRT) in national and international guidelines. [10][11][12] One of the main advantages promoted for preemptive transplantation is improved patient and allograft survival. [10][11][12] One of the main advantages promoted for preemptive transplantation is improved patient and allograft survival.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] The number of preemptive transplants performed is now being used as a performance benchmark in certain jurisdictions. [10][11][12] One of the main advantages promoted for preemptive transplantation is improved patient and allograft survival. [13][14][15][16][17][18] Other advantages of preemptive transplantation include improved quality of life and lower cost.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

Irish

Chadban

McDonald

et al. 2019

American Journal of Transplantation

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Preemptive kidney transplantation is the preferred initial renal replacement therapy, by avoiding dialysis and reportedly maximizing patient survival. Lead time bias may account for some or all of the observed survival advantage, but the impact of this has not been quantified. Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we included adult recipients of living donor kidney transplants during 1998‐2017. Patients were transplanted preemptively (n = 1435) or after receiving up to 6 months of dialysis (n = 712). We created a matched cohort using propensity scores, and accounted for lead time (dialysis and estimated predialysis) using left‐truncated Cox models with the primary outcome of patient survival. The median eGFR at transplantation was 6.9 mL/min per 1.73 m2 in the non‐pre‐emptive, and 9.6 mL/min per 1.73 m2 in the preemptive group. In the matched cohort (n = 1398), preemptive transplantation was not associated with a survival advantage hazard ratio (HR) for preemptive vs non‐pre‐emptive 1.12 (95% confidence interval [CI] 0.79‐1.61). Accounting for lead time moved the point estimates toward a survival disadvantage for preemptive transplantation (eg, HR assuming 4 mL/min per 1.73 m2/year eGFR decline, 1.21 [0.85, 1.73]), but in all cases the 95% CIs crossed 1. The optimal timing of preemptive living donor kidney transplantation requires further study.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

Irish

Chadban

McDonald

et al. 2019

American Journal of Transplantation

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“…Inputs from key stakeholders, especially the PD centers, are essential. The Thai PD First Policy has been relatively successful despite being in resource‐limited settings, while attempts to continuously monitor the structure, process, and outcomes of PD services have been benchmarked against some selected international indicators in the same manner as in other well‐performing institutions overseas …”

Section: Discussionmentioning

confidence: 99%

National feasibility survey of peritoneal dialysis key performance indicators in Thailand from provider perspective

et al. 2019

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Background: Peritoneal dialysis (PD) has been the main method of renal replacement therapy under the "PD First" policy in Thailand since 2008. Initially, the proposed 13 key performance indicators (KPIs) raised feasibility concerns because of inequitable distribution of resources such as laboratory facilities and/or specialized healthcare staff for PD care throughout the country.Methods: Data availability and goals from the health-care providers' perspective were explored using an online questionnaire survey for all PD centers registered with the Nephrology Society of Thailand from May to June 2016. The availability of essential data required for each KPI indicator to achieve the desired target was assessed using a 5-point Likert scale.Results: Of the 197 centers, 119 responded to the survey (response rate of 60.41%).PD indicators with a high percentage of strongly disagree or disagree were "PD adequacy measured in the last 12 months" (26.83%), "Total weekly Kt/V ≥ 1.7" (24.59%), "3-year PD technique survival" (21.31%), "Serum parathyroid levels within 150 to 500 pg/mL" (16.94%), and a "3-year PD patient survival" (19.01%). As many as 34.17%, 39.19%, 27.27%, 28.93%, and 22.00%, respectively, did not anticipate that Talerngsak Kanjanabuch and Krit Pongpirul share co-first authorship.

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“…In this approach, performance indicators (van der Geer et al ) have been used based on existing or purposefully collected data (Scobie et al ) for various management purposes, for instance, to identify poor performance (Mant ), to monitor poorly performing healthcare services and to support quality improvement (Mainz ). Several sets of performance indicators have been developed, targeting at either overall organisations (Veillard et al ; Arah et al ; Love et al ; Gu & Itoh ) or specific specialties or fields (Baars et al ; Centers for Medicare & Medicaid Services ; Smith & Hayward ; Toussaint et al ). A general‐purposed system has a huge set of indicators applicable to any type of organisations.…”

Section: Introductionmentioning

confidence: 99%

“…To date only a few performance indicators specific to dialysis and its related fields have been suggested. For instance, six renal key performance indicators were proposed by the Department of Health Victoria (Toussaint et al ). In other studies, performance indicators were mainly focused on chronic kidney disease (CKD) and limited to its clinical quality or adequacy (Centers for Medicare & Medicaid Services ; Smith & Hayward ).…”

Section: Introductionmentioning

confidence: 99%

Performance measures for a dialysis setting

Itoh

2017

Journal of Renal Care

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Gu X., Itoh K. (2018). Performance measures for a dialysis setting. Journal of Renal Care 44(1), 52-59. S U M M A R YObjectives: This study from Japan extracted performance measures for dialysis unit management and investigated their characteristics from professional views. Methods: Two surveys were conducted using self-administered questionnaires, in which dialysis managers/staff were asked to rate the usefulness of 44 performance indicators. A total of 255 managers and 2,097 staff responded. Results: Eight performance measures were elicited from dialysis manager and staff responses: these were safety, operational efficiency, quality of working life, financial effectiveness, employee development, mortality, patient/employee satisfaction and patient-centred health care. These performance measures were almost compatible with those extracted in overall healthcare settings in a previous study. Internal reliability, content and construct validity of the performance measures for the dialysis setting were ensured to some extent. As a general trend, both dialysis managers and staff perceived performance measures as highly useful, especially for safety, mortality, operational efficiency and patient/ employee satisfaction, but showed relatively low concerns for patient-centred health care and employee development. However, dialysis managers' usefulness perceptions were significantly higher than staff. Conclusions: Important guidelines for designing a holistic hospital/clinic management system were yielded. Performance measures must be balanced for outcomes and performance shaping factors (PSF); a common set of performance measures could be applied to all the healthcare settings, although performance indicators of each measure should be composed based on the application field and setting; in addition, sound causal relationships between PSF and outcome measures/ indicators should be explored for further improvement. K E Y W O R D S Dialysis therapy Holistic management Performance indicator Performance measurement B I O D A T AXiuzhu Gu is an Assistant Professor in the Department of Industrial Engineering and Economics at Tokyo Institute of Technology. She has a special interest in human factors, especially risk management in health care, and has conducted research on safety culture, error disclosure, and human error taxonomy. She also has an interest in operations management in health care, making efforts to improve healthcare efficiency and effectiveness from perspectives of important stakeholders such as patients, employees, management and community.

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Implementation of renal key performance indicators: Promoting improved clinical practice

Cited by 24 publications

References 23 publications

Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

National feasibility survey of peritoneal dialysis key performance indicators in Thailand from provider perspective

Performance measures for a dialysis setting

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