NDT Advance Access originally published online on April 18, 2008
Nephrology Dialysis Transplantation 2008 23(10):3227-3233; doi:10.1093/ndt/gfn195
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A practice-related risk score (PRS): a DOPPS-derived aggregate quality index for haemodialysis facilities
1 Humber River Regional Hospital, Weston, Ontario, Canada 2 Arbor Research Collaborative for Health, Ann Arbor, MI, USA 3 Queen's University, Kingston, Ontario 4 Maisonneuve Rosemont Hospital, University of Montreal, Montreal 5 Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Québec, Canada 6 Toyko Women's Medical University, Tokyo, Japan 7 Amgen, Inc., Thousand Oaks, CA, USA 8 Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan 9 Ghent University Hospital, Ghent, Belgium
David C. Mendelssohn, University of Toronto, 200 Church St., Room 2024, Weston, Ontario, M5N 1N8, Canada. Tel: +1-416-243-4368; Fax: +1-416-243-4421; E-mail: dmendelssohn{at}hrrh.on.ca
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Abstract |
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Background. The Dialysis Outcomes and Practice Patterns Study (DOPPS) database was used to develop and validate a practice-related risk score (PRS) based on modifiable practices to help facilities assess potential areas for improving patient care.
Methods. Relative risks (RRs) from a multivariable Cox mortality model, based on observational haemodialysis (HD) patient data from DOPPS I (1996–2001, seven countries), were used. The four practices were the percent of patients with Kt/V 
1.2, haemoglobin 11 g/dl (110 g/l), albumin 4.0 g/dl (40g/l) and catheter use, and were significantly related to mortality when modelled together. DOPPS II data (2002–2004, 12 countries) were used to evaluate the relationship between PRS and mortality risk using Cox regression.
Results. For facilities in DOPPS I and II, changes in PRS over time were significantly correlated with changes in the standardized mortality ratio (SMR). The PRS ranged from 1.0 to 2.1. Overall, the adjusted RR of death was 1.05 per 0.1 points higher PRS (P < 0.0001). For facilities in both DOPPS I and II (N = 119), a 0.2 decrease in PRS was associated with a 0.19 decrease in SMR (P = 0.005). On average, facilities that improved PRS practices showed significantly reduced mortality over the same time frame.
Conclusions. The PRS assesses modifiable HD practices that are linked to improved patient survival. Further refinements might lead to improvements in the PRS and will address regional variations in the PRS/mortality relationship.
Keywords: dialysis outcomes and practice patterns study; haemodialysis; patient risk score; survival; quality index
Received for publication: 2. 8.07
Accepted in revised form: 13. 3.08