United states renal data system assessment of the impact of the national kidney foundation-dialysis outcomes quality initiative guidelines
United states renal data system assessment of the impact of the national kidney foundation-dialysis outcomes quality initiative guidelines
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DOI：
10.1053/ajkd.2002.31999
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发表时间：
2002-04-01
影响因子：
13.2
通讯作者：
Constantini, E
中科院分区：
文献类型：
--
作者：
Collins, AJ;Roberts, TL;Constantini, E
自1989年以来，美国一直致力于改善透析患者的护理。许多组织已经制定了临床实践指南;然而，很少有指南得到了国家肾脏基金会-透析结果质量倡议（DOQI）的广泛支持。这些指南是在广泛回顾文献的基础上独立制定的，包括透析充分性、贫血治疗和血管通路等章节。为了评估这些指南对临床实践的影响，我们使用医疗保险透析提供者索赔和医疗保险B部分医生服务评估了血细胞比容、重组人促红细胞生成素剂量、血液透析充分性、简单瘘管和透析导管利用率的数据。除红细胞压积测量审核有效期外，红细胞压积稳步增加。该政策取消后，血细胞比容增加至DOQI目标范围的中点（34.4%）。虽然透析治疗水平已经稳定，1997 - 1999年平均尿素减少率为68%-69.9%，略高于DOQI目标65%或更高，但地理差异性很明显。从1994年到1999年，在DOQI之前和DOQI之后，简单的瘘管放置率增加了45%。临时导管的使用减少，而永久性导管的放置增加，这可能反映了推荐的实践指南。尽管临床实践指南似乎改善了透析患者的临床护理，但全国各地护理的相当大的区域差异应引起高度重视。(C)2002年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Since 1989, significant efforts have focused on improving the care of dialysis patients In the United States. Numerous organizations have developed clinical practice guidelines; however, few guidelines have received the broad support given to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (DOQI). These guidelines, independently developed from an extensive review of the literature, include sections on dialysis adequacy, anemia treatment, and vascular access. To assess the impact of these guidelines on clinical practice, we evaluated data on hematocrits, recombinant human erythropoietin dosing, hemodialysis adequacy, and simple fistula and dialysis catheter utilization using Medicare dialysis provider claims and Medicare Part B physician services. Hematocrits have increased steadily, with the exception of the period when the Hematocrit Measurement Audit was in effect. After cancellation of the policy, hematocrits Increased to the midpoint of the DOQI target range (34.4%). Although the level of dialysis therapy has stabilized, with the average urea reduction rate of 68% to 69.9% in 1997 to 1999 being slightly greater than the DOQI target of 65% or greater, geographic variability Is apparent. Simple fistula placement rates increased by 45% during the pre-DOQI and post-DOQI period from 1994 to 1999. The use of temporary catheters decreased, whereas placement of permanent catheters has increased, which may reflect recommended practice guidelines. Although it appears that clinical practice guidelines have improved the clinical care of dialysis patients, considerable regional variations in care across the country should be given significant attention. (C) 2002 by the National Kidney Foundation, Inc.