NKF: Dialysis Clinics Perform Similarly in City or Burbs

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NKF: Dialysis Clinics Perform Similarly in City or Burbs

By Ed Susman, Contributing Writer, MedPage Today
Published: April 30, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner   
Action Points 
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


Explain that patient care at dialysis clinics appears to be similar in urban and suburban areas based on a retrospective analysis of multiple quality measures.
LAS VEGAS -- Patient care at dialysis clinics appears to be similar in urban and suburban areas, according to a report at the National Kidney Foundation Spring Clinical Meetings.

The average score on the DaVita Quality Index (DQI) for 63 inner-city clinics was 68.37 compared with a score of 67.35 for 1,298 suburban clinics (P=0.15), said Rich Mutell, MBA, director of health economics and informatics for DaVita Clinical Research, based in Minneapolis.

The DQI is a proprietary benchmarking tool that ranks an individual dialysis clinic's performance against company-wide results on a 100-point scale. Mutell reviewed the data culled form the national DaVita database of 100,000 people being treated for end-stage renal disease.

For this retrospective analysis, the researchers looked at whether patients in both groups had received proper vaccinations, if their anemia was under control, and how many had access to a type of dialysis that minimizes the risk of infections.

They also noted how efficient dialysis was in removing toxins from patients' bodies and the percentage of patients with healthy blood levels of parathyroid hormone, calcium, phosphorus, and albumin. Data for the inner-city clinics included 7,530 patients; data from the suburban clinics included 100,386 patients.

Among the outcomes, only albumin score appeared to differ significantly, with higher scores among the inner-city patients: An average 6.40 on the DQI for albumin compared with 5.91 among the patients in the suburban clinics (P<0.01). However, Mutell said that the overall quality index showed no statistical difference.

A dialysis facility had to meet two criteria in order to be classified as inner- city: More than 20% of the households lived below the poverty line based on U.S. postal zip codes and a population density of over 10,000 people per square mile.

"These results show no differences in patient outcomes between inner-city and non-inner city units," Mutell told MedPage Today.

Mutell said this study was undertaken because of other reports suggesting that the quality of dialysis care for urban patients living in poverty was below national standards. He pointed out that the flaw in those studies was the use of "single quality measures rather than a comprehensive suite of metrics."

"It is not so surprising to me that there were not huge differences in outcomes," commented Jeffrey Berns, MD, associate chief of renal, electrolyte, and hypertension division of the Perelman Center for Advanced Medicine at the University of Pennsylvania in Philadelphia.

"A lot of the care provided in a dialysis clinic is protocolized and that [protocol] would get applied similarly, whether in a suburban facility or an urban one," Berns told MedPage Today.

While the presumed disadvantage between urban and suburban dialysis clinics may be questionable, Mutell noted that inner-city clinics could be perceived to provide better care because patients have easier access, either through proximity to the clinic or better transportation options.

Mutell had no disclosures.

Berns disclosed financial relationships with Amgen, Wyeth, Litholink, and Affymax.



Primary source: National Kidney Foundation
Source reference:
Mutell R, et al "Inner-city dialysis clinics perform well on quality metrics" NKFA 2011; Abstract 375.
http://www.medpagetoday.com/MeetingCoverage/NKF/26209