| Dialysis practices that distinguish facilities with below- versus above-expected mortality. | |
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MedLine Citation:
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PMID: 20876677 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVES: Mortality rates vary widely among dialysis facilities even after adjustment with standardized mortality ratios (SMRs). This variation may occur because top-performing facilities use practices not shared by others, because the SMR fails to capture key patient characteristics, or both. Practices were identified that distinguish top- from bottom-performing facilities by SMR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cross-sectional survey was performed of staff across three organizations. Staff members rated the perceived quality of their units' patient-, provider-, and facility-level practices using a six-point Likert scale. Facilities were divided into those with above- versus below-expected mortality on the basis of SMRs from U.S. Renal Data Service facility reports. Mean Likert scores were computed for each practice using t tests. Practices that were statistically significant (P ≤ 0.05) and achieved at least a medium effect size of ≥0.4 were reported. Significant predictors were entered into a linear regression model. RESULTS: Dialysis facilities with below-expected mortality reported that patients in their unit were more activated and engaged, physician communication and interpersonal relationships were stronger, dieticians were more resourceful and knowledgeable, and overall coordination and staff management were superior versus facilities with above-expected mortality. Staff ratings of these practices explained 31% of the variance in SMRs. CONCLUSIONS: Patient-, provider-, and facility-level practices partly explain SMR variation among facilities. Improving SMRs may require processes that reflect a coordinated, multidisciplinary environment (i.e., no one group, practice, or characteristic will drive facility-level SMRs). Understanding and improving SMRs will require a holistic view of the facility. |
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Authors:
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Brennan Spiegel; Roger Bolus; Amar A Desai; Philip Zagar; Tom Parker; John Moran; Matthew D Solomon; Osman Khawar; Matthew Gitlin; Jennifer Talley; Allen Nissenson |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2010-09-28 |
Journal Detail:
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Title: Clinical journal of the American Society of Nephrology : CJASN Volume: 5 ISSN: 1555-905X ISO Abbreviation: Clin J Am Soc Nephrol Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-08 Completed Date: 2011-02-18 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 101271570 Medline TA: Clin J Am Soc Nephrol Country: United States |
Other Details:
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Languages: eng Pagination: 2024-33 Citation Subset: IM |
Affiliation:
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Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. bspiegel@mednet.ucla.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Attitude of Health Personnel Benchmarking Cross-Sectional Studies Delivery of Health Care, Integrated / statistics & numerical data Female Health Care Surveys Health Facilities / statistics & numerical data* Health Knowledge, Attitudes, Practice Humans Kidney Failure, Chronic / mortality*, therapy* Linear Models Male Outcome and Process Assessment (Health Care) / statistics & numerical data* Patient Care Team / statistics & numerical data Physician-Patient Relations Practice Guidelines as Topic Quality Indicators, Health Care / statistics & numerical data Questionnaires Renal Dialysis / mortality* Treatment Outcome United States / epidemiology |
| Comments/Corrections | |
Comment In:
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Clin J Am Soc Nephrol. 2010 Nov;5(11):1905-7
[PMID:
20947787
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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