Behind the Huge Variations in Dialysis Patient Mortality

Cheryl Clark, for HealthLeaders Media , October 21, 2010

Likewise, physicians' interaction with patients was in a respectful manner, and dieticians addressed patients' cultural issues in preparing nutritional plans, two other factors seen as more likely at centers with lower mortality.

And there were more multi-disciplinary conferences among staff after a patient returned from a hospitalization, which "may be associated with improved mortality," the authors wrote.

Lastly, they wrote, that in lower mortality dialysis centers, personnel "perceive a higher quality of staff management and education. Specifically, top units are more likely to call for per diem help if there is unexpected short staffing, and have a higher perceived quality of continuing medical education programs for staff."  In short, they have "a more staff-oriented and friendly environment."

"We found that personnel in facilities with low mortality rates perceive their patients to be more cooperative, willing to learn, compliant, self-efficacious, independent, and accountable compared with patients in high mortality units," the authors wrote.

"We identified many factors that may enhance survival in dialysis, and we hope our findings can pave the way for future quality improvement initiatives," Brennan M.R. Spiegel, MD, of the Greater Los Angeles Healthcare System and lead author of the report said in a statement.

Of course it's possible, Spiegel and his co-authors wrote, that accepted criteria to adjust for risk in these patients, age, sex, race, disease duration, co-morbidities, nursing home status and BMI, is inadequate or faulty.  There may be numerous other indicators.

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