[Accumulated experience in the analysis of quality indicators in a haemodialysis unit]. / Experiencia acumulada en el análisis de indicadores de calidad en una unidad de hemodiálisis.

ABSTRACT

INTRODUCTION: The object of this work was to review our use of various indicators of haemodialysis within the guidelines of good clinical practice. MATERIALS AND METHODS: The study includes all patients from our haemodialysis program from June 2005 to February 2008. The indicators we evaluated included various areas anaemia, bone-mineral metabolism, dialysis dose, cardiovascular risk, vascular access and morbidity/ mortality. The measurement intervals varied according to the parameter being evaluated. RESULTS: We gathered those indicators in which we found a difference between our results and the targets set. It is possible to reach a haemoglobin of > or = 11 g/dl in more than 85% of the patients, although more than 20% of them showed > 13 g/dl. We were able to stay on target with phosphorous (> 85%) but not with calcium (72.7%) or PTH (38.8%) although average values were improved. The incorporation of new patients to the haemodialysis programme, some previously unknown, limited our possibilities of achieving > or = 85% with a Kt/V > or = 1.3. Only 62.2% of the patients had a systolic blood pressure of < or = 140 mmHg. The percentage of patients dialysed by catheter (objective < 10%) was only achieved in five out of the eleven measures. The hospitalisation rate was between 0.49 and 0.71 episodes/patient/year. The patient survival rates coincide with those of the Comunidad Valenciana Register. CONCLUSION: the use of clinical performance measures has improved our results, whilst in some cases it has raised doubts over their definition and established targets. In general we feel that they should be revised and redefined where necessary in an attempt to avoid variability, iatrogenia, and increased costs. The use of only those indicators in which a clear scientific basis is evident, should be considered.