Variable Mortality Rates among Dialysis Treatment Centers
Variable Mortality Rates among Dialysis Treatment Centers
复制标题
透析治疗中心的不同死亡率
DOI：
10.7326/0003-4819-117-4-332
复制
发表时间：
1992
影响因子：
39.2
通讯作者：
R. Gutman
中科院分区：
文献类型：
--
作者：
W. McClellan;W. Flanders;R. Gutman
客观化
研究在特定地理区域内接受肾透析设施治疗的患者死亡风险的变化。
设置
东南部一个州的所有独立和基于医院的透析设施都向注册中心报告。
设计
对透析患者队列进行为期1年的终末期肾病登记。
病人
1987年，有3612名年龄在20岁及以上的患者在透析机构接受治疗，并向登记处报告。
测量
人口统计学指标、合并症指标和疾病严重程度指标是从患者记录中提取出来的。具体设施的风险估计是根据Cox比例风险模型得出的。
结果
特定设施的死亡率在每10,000个病人日中有2.0至10.5人死亡。老年人、白人、有糖尿病肾病、心绞痛或充血性心力衰竭病史的患者以及营养或功能状态受损的患者的死亡率较高。每种死亡危险因素在不同设施中的患病率差异很大。在第75个风险百分位数的设施中，未调整的死亡风险是处于中位数的设施的1.3倍，而在第25个百分位数，其可能性是0.68倍--风险范围是两倍。控制患者特征患病率的差异不会改变风险的四分位数范围，机构的调整后的风险估计与其未调整的估计显示出很强的相关性(R2，0.566；P<0.0001)。
结论
与死亡风险增加相关的患者属性在不同的透析机构中差异很大。然而，对这些差异的调整并没有实质性地改变死亡率风险的变化程度或设施死亡率的相对排名。
OBJECTIVE
To examine the variation in the risk for mortality among patients treated at renal dialysis facilities within a defined geographic area.
SETTING
All free-standing and hospital-based dialysis facilities in a single southeastern state reported to the registry.
DESIGN
Cohort of dialysis patients followed for 1 year by an end-stage renal disease registry.
PATIENTS
Patients (n = 3612) aged 20 years and older receiving treatment at the dialysis facilities reporting to the registry during 1987.
MEASUREMENTS
Demographic, comorbid, and severity of illness indicators were abstracted from patient records. Facility-specific risk estimates were derived from a Cox proportional hazards model.
RESULTS
Facility-specific mortality rates ranged between 2.0 and 10.5 deaths per 10,000 patient days. Mortality rates were higher among older persons; whites; those with a history of diabetic nephropathy, angina, or congestive heart failure; and patients with either nutritional or functional status impairment. Facility-specific prevalence of each mortality risk factor varied widely. The unadjusted risk for death in a facility at the 75th percentile of risk was 1.3 times that of a facility at the median, whereas at the 25th percentile, it was 0.68 times as likely--a twofold range of risk. Controlling for differences in the prevalence of patient characteristics did not change the interquartile range in risks, and a facility's adjusted risk estimate showed a strong correlation with its unadjusted estimate (R2, 0.566; P less than 0.0001).
CONCLUSIONS
Patient attributes associated with increased risk for mortality vary widely among dialysis facilities. Adjustment for these differences did not, however, substantially change either the degree of variation in mortality risks or the relative ranking of a facility's mortality.