BACKGROUND: We evaluated whether incremental achievement of up to 8 facility quality goals was associated with improvement in facility-specific mortality and hospitalization rates. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: 1,085 Fresenius Medical Care, North America facilities providing hemodialysis (HD) for 25 or more patients during January 2006. MEASUREMENTS: The facility average for the period up to December 31, 2006, was used to determine achievement of each goal for equilibrated Kt/V, missed HD treatments, hemoglobin level, bicarbonate level, albumin level, phosphorus level, fistulae, and HD catheters. Linear regression models were used to relate facility-wide achievement of goals with facility-specific hospital days and standardized mortality ratios. RESULTS: Most facilities (64%) achieved 2 to 4 of 8 goals, with only 8% meeting more than 5 quality goals. Achieving more than 5 goals averaged 3.5 fewer hospital days/patient-year and 20% lower standardized mortality ratios (all P < 0.001). The incremental number of goals met also was associated with improvement in facility mortality (P < 0.001) and hospital days (P < 0.001). Catheter and albumin level goals were achieved least (6% and 9% of facilities, respectively), but they had the best outcomes. Facilities achieving more than 5 goals had older patients (64.0 versus 61.5 years; P < 0.001), fewer African American patients (16% versus 38%; P < 0.001), and fewer women (44% versus 46%; P = 0.003) compared with the average. LIMITATIONS: Observational design with residual confounding from unmeasured patient-, facility-, and treatment-related factors. CONCLUSIONS: Achieving more facility quality goals was significantly associated with better facility-based measurements of patient outcomes. Although these results do not establish a causal relationship, findings agree with the present practice of monitoring facility performance for continuous quality improvement.
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机译：背景：我们评估了最多达到8个设施质量目标的增量实现是否与特定于设施的死亡率和住院率的提高相关。研究设计：前瞻性观察研究。机构和参与者：2006年1月在北美的1,085费森尤斯医疗中心为25位或以上的患者提供血液透析（HD）。测量：截至2006年12月31日的平均设施用于确定实现以下目标的每个目标平衡的Kt / V，错过的HD治疗，血红蛋白水平，碳酸氢盐水平，白蛋白水平，磷水平，瘘管和HD导管。线性回归模型用于将设施范围内目标的实现与特定设施的住院天数和标准化死亡率进行关联。结果：大多数机构（64％）达到了8个目标中的2-4个，只有8％达到了5个以上的质量目标。超过5个目标的平均住院天数/患者年减少3.5天，标准死亡率降低20％（所有P <0.001）。达到的目标数量的增加还与机构死亡率（P <0.001）和住院天数（P <0.001）的改善相关。导管和白蛋白水平的目标达到最少（分别为设施的6％和9％），但结果最佳。达到5个以上目标的机构中，老年患者（64.0岁对61.5岁; P <0.001），非裔美国人患者较少（16％对38％; P <0.001）和女性较少（44％对46％; P = 0.003）与平均值相比。局限性：观察性设计，其残留的杂物来自无法衡量的患者，设施和治疗相关因素。结论：实现更高的设施质量目标与更好的基于设施的患者预后评估密切相关。尽管这些结果没有建立因果关系，但发现与当前监视设施性能以持续改善质量的做法相符。
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