Identifying best practices in dialysis care: results of cognitive interviews and a national survey of dialysis providers.

Clinical Journal of the American Society of Nephrology : CJASN
Amar A DesaiBrennan M R Spiegel

Abstract

Because there is wide variation in case-mix adjusted outcomes across dialysis facilities, it is possible that top-performing facilities use practices not shared by others. We sought to catalogue "best practices" that may account for interfacility variations in outcomes. This multidisciplinary study identified candidate best practices in dialysis through a staged process, including systematic review, cognitive interviews, and a national "virtual focus group" of dialysis providers. The resulting candidate practices were rank-ordered by perceived importance as determined by mean RAND Appropriateness Scores from a national survey of nephrologists, nurses, and opinion leaders. A total of 155 candidate best practices were identified. Among these, respondents believed dialysis outcomes are most strongly related to 1) characteristics of multidisciplinary care conferences, 2) technician proficiency in protecting vascular access, 3) training of nurses to provide education in fluid management, vascular access, and nutrition, 4) use of random and blinded audits of staff performance, and 5) communication and teamwork among staff. In contrast, there was wide disagreement about the importance of facility-based health maintenance practices, op...Continue Reading

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Citations

Apr 13, 2012·Seminars in Dialysis·Rebecca L WingardAlex Rosenblum
Sep 30, 2010·Clinical Journal of the American Society of Nephrology : CJASN·Brennan SpiegelAllen Nissenson
Apr 3, 2009·Clinical Journal of the American Society of Nephrology : CJASN·Amar A DesaiBrennan M R Spiegel
Jun 11, 2011·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·William A Wolfe
May 25, 2010·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Brennan M R SpiegelAllen Nissenson
Jun 26, 2015·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Raymond VanholderWim Van Biesen
Jun 9, 2012·Journal of the American Society of Nephrology : JASN·Raymond VanholderUNKNOWN Dialysis Advisory Group of American Society of Nephrology
Aug 10, 2013·Clinical Journal of the American Society of Nephrology : CJASN·Cynthia B WhitmanBrennan M R Spiegel
Oct 16, 2010·Clinical Journal of the American Society of Nephrology : CJASN·William McClellan
Aug 12, 2021·PloS One·Anita van Eck van der SluijsAlferso C Abrahams
Oct 3, 2021·Journal of the American Society of Nephrology : JASN·Jingbo NiuKevin F Erickson

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