Supplementary Material for: Effect of a Quality Improvement Program to Improve Guideline Adherence and Attainment of Clinical Standards in Dialysis Care: Report of Outcomes in Year 1

Background: Best practice in dialysis is synthesised in
clear international guidelines. However, a large gap remains between
the international guidelines and the actual delivery of care. In this
paper, we report outcomes for the first year of a multifaceted dialysis
improvement programme in our network. Methods: One year
collaborative involving 3 haemodialysis units and a peritoneal dialysis
(PD) programme involving 299 dialysis patients. Each unit addressed a
different indicator (unit A - catheter-related bloodstream infection
[CRBSI], unit B - pre-dialysis blood pressure [BP], unit C - dialysis
dose, unit D - anaemia) with a shared aim to match the top 10% in the
UK. Tailored multifaceted approaches include a modified collaborative
methodology with an aim, framework, driver diagram, learning sessions,
facilitated meetings, plan-do-study-act cycles and continuous
measurement. Analysis of outcomes, costings, erythropoietin stimulating
agent and iron use, and safety culture attributes. Results: Unit A reduced CRBSI from 2.65 to 0.5 per 1,000 catheter days (p = 0.02). Unit B improved attainment of target BP from 37.5 to 67.2% (p = 0.003). Unit C improved attainment of target urea reduction ratio from 75.8 to 91.4% (p = 0.04). PD unit D improved attainment of target haemoglobin from 45.5 to 62.7% (p
= 0.01), with no significant change in the indicators in a
non-intervention unit. Safety culture attributes improved. Costs
associated with admission for fluid overload and infection,
erythropoietin, iron and thrombokinase use decreased 36%
(£415,620-£264,143). Conclusions: Units that took part in
this collaborative improved guideline adherence compared both to their
own pre-intervention performance and a non-intervention unit. Such
multifaceted interventions are a useful methodology to improve dialysis
care.

背景：血液透析的最佳实践已在国际指南中得以综合。然而，国际指南与实际护理提供之间仍存在较大差距。在本研究中，我们报告了我国网络中一项多维度血液透析改进计划第一年的成果。方法：一项为期一年的合作研究，涉及3个血液透析单元和299名透析患者组成的腹膜透析（PD）计划。每个单元针对不同的指标进行改进（单元A - 导管相关血流感染[CRBSI]，单元B - 透析前血压[BP]，单元C - 透析剂量，单元D - 贫血）并共同致力于达到英国顶尖10%的水平。定制化的多维度方法包括改进的合作方法、目标框架、驱动图、学习课程、促进会议、计划-执行-研究-行动循环以及持续测量。分析成果、成本、红细胞生成素刺激剂和铁的使用，以及安全文化属性。结果：单元A将CRBSI的比率从每1000个导管日2.65降至0.5（p=0.02）。单元B提高达到目标血压的比例从37.5%增至67.2%（p=0.003）。单元C提高达到目标尿素降低比率的实现度从75.8%增至91.4%（p=0.04）。PD单元D将目标血红蛋白的实现度从45.5%提升至62.7%（p=0.01），而在非干预单元中，指标没有显著变化。安全文化属性得到改善。与液体超负荷和感染、红细胞生成素、铁和血栓溶解酶使用相关的成本下降了36%（从415,620英镑降至264,143英镑）。结论：参与此合作计划的单元，其指南遵守度较干预前自身表现及非干预单元均有显著提升。此类多维度干预措施是改善透析护理的有用方法。