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Cited by 40Dialysis and Renal Disease ManagementHealthcare Quality and ManagementHealth Policy Implementation Science

A Randomized Evaluation of Two Health Care Quality Improvement Program (HCQIP) Interventions to Improve the Adequacy of Hemodialysis Care of ESRD Patients: Feedback Alone versus Intensive Intervention

McClellan, William M., Hodgin, Emily, Pastan, Stephen, McAdams, Lisa, Soucie, Michael·2004·Journal of the American Society of Nephrology
DOI 10.1097/01.asn.0000115701.51613.d7
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Abstract

End-stage renal disease (ESRD) Networks are quality improvement organizations that collect, analyze, and report information to clinicians and allied health providers about discrepancies between observed patterns of care of ESRD patients and what has been recommended by clinical practice guidelines. The Networks facilitate response to this information by assisting ESRD treatment centers to develop quality improvement programs to redress inadequate care. The authors evaluated this process of quality improvement by selecting 42 treatment centers in a single ESRD Network with the lowest facility-specific mean urea reduction ratio (URR). The treatment centers were randomly assigned to two intervention strategies: (1) feedback alone; (2) an intensive intervention that included feedback, workshops, distribution of educational materials and clinical practice guidelines, technical assistance with the development of quality improvement plans, and continued monitoring. The intensive intervention had greater improvement in the increased proportions of patients dialyzed with prescribed blood flow (P = 0.02) and documented review of prescription (P = 0.01). Furthermore, the mean center URR increased nearly 3% among intensive intervention centers (from 68.1 to 70.9) but only 0.09% among the feedback centers (68.2 to 69.1) (P = 0.002). Similarly, time on dialysis increased 7.5 min on average among patients in intervention centers but decreased 2 min for patients in comparison centers (P = 0.03). These results demonstrate that Network feedback, coupled with the intensive intervention, resulted in improvement in care that would otherwise not have occurred.

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Crossref · 10.1097/01.asn.0000115701.51613.d7

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21 of 21 references verified0 citation errors · 0 not checkable

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  • McClellan 2004 found small but potentially clinically meaningful improvements in the management of dialysis by adding a multifaceted intervention including educational outreach to feedback (difference in mean urea reduction ratio: P = 0.002).

    “McClellan 2004 found small, but potentially clinically meaningful improvements in the management of dialysis by adding a multifaceted intervention including educational outreach to feedback (difference in mean urea reduction ratio: P = 0.002)”

    From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as McClellan 2004

  • McClellan 2004 found no statistically significant improvement in the primary outcome (proportion of patients with urea reduction ratio > 65%: adjusted RD = 0.70%; P = 0.8).

    “no statistically significant improvement in the primary outcome (proportion of patients with urea reduction ratio > 65%: adjusted RD = 0.70%; P = 0.8)”

    From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as McClellan 2004

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Authors
McClellan, W. M., Hodgin, E., Pastan, S., McAdams, L., & Soucie, M.
Affiliations
  • Emory University (US)
  • Centers for Medicare and Medicaid Services (US)
Corresponding author
McClellan, William M.
ORCID
Pastan, Stephen
Venue
Journal of the American Society of Nephrology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2004-03
Volume
15
Issue
3
Pages
754-760
ISSN
1046-6673 (ISSN-L)
DOI
10.1097/01.asn.0000115701.51613.d7
OpenAlex
W2048183589
Cited by
40
References
21
Citations by year
2025: 2 · 2024: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 1 · 2013: 2 · 2012: 3
FWCI
1.11
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of the American Society of Nephrology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
end-stage renal disease, hemodialysis, quality improvement programs, urea reduction ratio, dialysis prescription, blood flow rate, dialysis duration, performance feedback, treatment centers
MeSH terms
Feedback, Female, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Middle Aged, Quality Assurance, Health Care, Program Evaluation

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