The ‘Centre Effect’ in Nephrology: What Do Differences between Nephrology Centres Tell Us about Clinical Performance in Patient Management?

Abstract

Improving the quality of care provided by nephrology centres to patients with kidney disease requires a clear understanding of how to compare performance after adjustment for case mix, combined with a detailed understanding of the structure and processes that are associated with the achievement of good clinical results. In this review, we discuss how to measure quality of care (using process or outcome measures), how to take case mix into account, how best to display comparisons between nephrology centres, and how to study the causes of real variations in quality between centres. This is a narrative review; we include examples from other fields in which the centre effect has been studied, including education.

UK Renal Registry 18th Annual Report: Chapter 6 Comorbidities and Current Smoking Status amongst Patients starting Renal Replacement Therapy in England, Wales and Northern Ireland from 2013 to 2014

“…This also applies when comparing survival in different treatment groups at centre [10][11][12] and international level [13]. The aim of this work is to describe the completeness of comorbidity data submitted to the UKRR and the prevalence of comorbid conditions and current smoking status in patients starting RRT.…”

Learning from practice variation to improve the quality of care

“…18 Finally, collection of a reliable data set should be followed by a multilevel modelling statistical approach that analyses centre performance after adjustment for patient-level characteristics. 19 …”

Association between surgical volume and failure of primary total hip replacement in England and Wales: findings from a prospective national joint replacement register

“…A between-consultant effect is essentially a cross-sectional analysis that compares the performance of one consultant against another and is highly likely to be confounded by centre-level effects. 16 A within-consultant effect is based on individual time series data and compares the changes of volume across time within the same consultant. Correspondingly, within effects can be interpreted more strongly, as the effect of changing a consultant’s personal volume, assuming centre-level factors remain relatively constant over the short-term analysis period.…”