Differences between hospitals in attainment of parathyroid hormone treatment targets in chronic kidney disease do not reflect differences in quality of care
| العنوان: | Differences between hospitals in attainment of parathyroid hormone treatment targets in chronic kidney disease do not reflect differences in quality of care |
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| المؤلفون: | Jack F.M. Wetzels, Jan A.J.G. van den Brand, Mieke J. Peeters, Peter J. Blankestijn, Marc A.G.J. ten Dam, Arjan D. van Zuilen |
| المصدر: | BMC Nephrology, 13, 82-82 BMC Nephrology BMC Nephrology, 13, pp. 82-82 BMC Nephrology, Vol 13, Iss 1, p 82 (2012) |
| بيانات النشر: | Springer Nature |
| مصطلحات موضوعية: | Nephrology, Male, medicine.medical_specialty, Multivariate analysis, Parathyroid hormone, Comorbidity, lcsh:RC870-923, chemistry.chemical_compound, Treatment targets, Internal medicine, Chronic kidney disease, Outcome Assessment, Health Care, medicine, Prevalence, Humans, Renal Insufficiency, Chronic, Renal disorder [IGMD 9], Netherlands, Quality of Health Care, Hyperparathyroidism, Creatinine, business.industry, Quality of care, Middle Aged, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Hospitals, Causality, Treatment Outcome, chemistry, Female, Hyperparathyroidism, Secondary, business, Biomarkers, Kidney disease, Research Article |
| الوصف: | Contains fulltext : 110897.pdf (Publisher’s version ) (Open Access) ABSTRACT: BACKGROUND: Transparency in quality of care (QoC) is stimulated and hospitals are compared and judged on the basis of indicators of performance on specific treatment targets. In patients with chronic kidney disease, QoC differed significantly between hospitals. In this analysis we explored additional parameters to explain differences between centers in attainment of parathyroid hormone (PTH) treatment targets. METHODS: Using MASTERPLAN baseline data, we selected one of the worst (center A) and one of the best (center B) performing hospitals. Differences between the two centers were analyzed from the year prior to start of the MASTERPLAN study until the baseline evaluation. Determinants of PTH were assessed. RESULTS: 101 patients from center A (median PTH 9.9 pmol/l, in 67 patients exceeding recommended levels) and 100 patients from center B (median PTH 6.5 pmol/l, in 34 patients exceeding recommended levels), were included. Analysis of clinical practice did not reveal differences in PTH management between the centers. Notably, hyperparathyroidism resulted in a change in therapy in less than 25% of patients. In multivariate analysis kidney transplant status, MDRD-4, and treatment center were independent predictors of PTH. However, when MDRD-6 (which accounts for serum urea and albumin) was used instead of MDRD-4, the center effect was reduced. Moreover, after calibration of the serum creatinine assays treatment center no longer influenced PTH. CONCLUSIONS: We show that differences in PTH control between centers are not explained by differences in treatment, but depend on incomparable patient populations and laboratory techniques. Therefore, results of hospital performance comparisons should be interpreted with great caution. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 1471-2369 |
| DOI: | 10.1186/1471-2369-13-82 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b21feb0536a129c5e3be50004a7f8c3b |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....b21feb0536a129c5e3be50004a7f8c3b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14712369 |
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| DOI: | 10.1186/1471-2369-13-82 |