The Quest to Standardize Hemodialysis Care

Abstract

A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety.

Knowing What We Do and Doing What We Should: Quality Assurance in Hemodialysis

“…The approach involves application of evidence-based guidelines and protocols to set clinical targets, and assessment of achievement of such targets using network-wide, standardized data processing [4]. A systematic collection, review and timely feedback of information to all clinics on the achievement of a list of eleven CPMs (table 2), as implemented by one provider organization, resulted in a consistent improvement of dialysis performance [4]. As one example, the percentage of patients meeting a target spKt/V ≥1.4 increased from 40% in 2000 to 85% in 2010 (fig.…”

“…A significant concern is to improve quality of care while simultaneously containing costs, promote patient safety and better quality of life (QoL) [3,4]. Quality of care can be defined as ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes' [5].…”

“…A quality assurance (QA) process in hemodialysis provides an opportunity to optimize dialysis-related medical practice and services, to the benefit of patients, healthcare professionals, dialysis providers and healthcare payers [3,4]. QA processes are complex, as they involve assessment of an array of clinical indicators, and the setting of targets that cover many aspects of control of uremia.…”

Implementation and Management of Strategies to Set and to Achieve Clinical Targets

“…Quality control, quality assurance and continuous quality improvement (CQI) processes derived from the manufacturing and industrial world have been progressively applied with success to medicine and in particular to the treatment of end stage renal disease. [1,2]. It is generally accepted that quality control describes the process for reviewing and checking that targets according to whether a defined set of criteria has been achieved, while quality assurance is the process in which systematic monitoring, collecting and evaluating the performance of a facility or a care network are assessed to ensure that standards of care are met [3].…”