Clinical target achievement is associated with better quality of life among dialysis patients: results from a continuous
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Clinical target achievement is associated with better quality of life among dialysis patients: results from a continuous quality improvement program in a Portuguese healthcare network Luca Neri1 · Pedro Ponce1 · Nicole Matias2 · Stefano Stuard1 · Krister Cromm1 Accepted: 30 May 2020 © Springer Nature Switzerland AG 2020
Abstract Background Patients with kidney failure have multifaced clinical needs. Continuous quality improvement (CQI) programs initiated by large healthcare provider networks bear the promise of improving guideline adherence and improving patientcentered outcome, including health-related quality of life (HRQOL). We aimed at evaluating the association between key performance indicators (KPI) adopted for our CQI and HRQOL in a large network of dialysis providers. Methods We conducted a survey study in 39 centers belonging to the Portuguese Fresenius Medical Care (FME) network, in September 2017. For each participant, we retrospectively extracted clinical information during the 6-month period preceding survey administration. We used this information to calculate KPI as defined by the FME-CQI policy. Those KPI were selected in the FME-CQI policy as modifiable intermediate endpoints for which previous evidence suggested a causal relationship with patients’ morbidity and mortality. HRQOL was assessed by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaire. Results Among 4691 eligible patients who were invited to participate in the survey, 2263 (48.2%) answered the selfadministered survey. Based on KPI standards, patients had 1.5 (± 1.2) off-target clinical parameters on average. KDQOL-36 score were generally higher than those observed in European reference population. We found a significant linear association between KPI parameters and HRQOL. This pattern was robust to adjustment for satisfaction scores. Conclusions Our data demonstrated a graded, monotonic, dose–response relationship between the number of off-target KPIs and HRQOL. Such relationship was not mediated by patients’ satisfaction and may be attributed to amelioration of diseasespecific symptoms and functional capacity. Keywords Chronic kidney disease · End stage renal disease · Health-related quality of life · Continuous quality improvement
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11136-020-02543-0) contains supplementary material, which is available to authorized users. * Luca Neri Luca.Neri@fmc‑ag.com 1
Director Clinical & Data Intelligence Systems ‑ Advanced Analytics, Fresenius Medical Care Deutschland GmbH, Via Papa Giovanni Paolo II, 41, 26020 Vaiano Cremasco, Italy
Fresenius Medical Care, FMCNA Fresenius Medical Care Portugal - Communication Department, Lisboa, Portugal
2
Recent advancements in the understanding of chronic kidney diseases and enhanced dialysis technologies was paralleled by a continuing effort in condensing evidence and disseminating up-to-date clinical guidance [1–6]. Nevertheless, clinical guidance uptake i
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