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About Dialysis Center Reports
The quality measures that are presented in your report are designed to help you make meaningful comparisons between dialysis centers that you may be considering for your treatments. "Quality" refers to how well a facility cares for its patients. Good quality dialysis care means doing the right thing at the right time and in the right way for the right person and getting the best possible results!
We have provided three accepted quality measures for your comparison of the dialysis centers you might be considering. The data we collect is gathered from the U.S. government, is updated regularly, and is carefully reviewed and displayed for your use. It is important that you recognize that these measures are one thing to consider in your selection of a dialysis center and that there are many other consideration you must consider. For example, you also might want to make sure that the dialysis center accepts your insurance coverage, or that the facility is close to your home.
Quality Measure #1
Hemodialysis Adequacy, or How Many Patients Receive Adequate Treatment at the Facility
The primary function of the kidneys is to filter waste from the blood. One of the most abundant waste material is a chemical known as "urea," a nitrogen containing substance found in the blood. The laboratory test that measures this substance is know as a BUN (blood urea nitrogen) test. BUN reflects the ratio between urea production and its clearance through the kidneys. This test is useful in following the progress of dialysis patients, and is normally performed before a patient has hemodialysis and also after the procedure is completed. The calculations performed on these two measurements are very important to the patient and is known as the URR (urea reduction ratio) and reflects the success of the treatment. The ratio is calculated in the following manner.
(BUN before dialysis - BUN after dialysis) / BUN before dialysis × 100
A URR of 65 or more means your dialysis treatment is adequate. You should know what this number is and make sure you discuss it with your doctor so you will have confidence that your treatment is adequate.
It also is important that dialysis centers make sure that the adequacy of the treatments they perform on patients is appropriate. One of the "quality measures" that you can look at to evaluate the performance of a dialysis center is to look at the percentage of patients who had enough waste removed from their blood based on the test results of the patients that are served by the specific dialysis center. Several factors can affect the percentage of a facility's patients who receive adequate dialysis. A facility may be able to control some of these factors, but not others. These factors can include:
- how well it cares for its patients,
- how healthy its patients are, and
- whether its patients have good health habits.
Quality Measure #2
How Well a Facility Controls Anemia Rates among Patients
Many dialysis patients have anemia, a type of low blood count. Anemia occurs when the amount of hemoglobin (the oxygen carrying molecules in the blood) is lower than the established normal range for humans (11 - 15 gm/dL). A simple test for this condition is known as the hematocrit, which refers both to the packed cell volume and to the percentage of the blood volume that is occupied by red blood cells. Another measure for anemia is a test for hemoglobin levels, and some facilities may measure this instead of the hematocrit.
When hematocrit is the measurement used, the lower limit of acceptability for dialysis patients is 33%. This number is important to you and you should know what this number is as many dialysis patients have anemia. You should always discuss this measurement with your doctor. At the facility level, the percentage of patients that have hematocrit levels higher than 33% is considered a quality measure for dialysis centers and reflects how well a center manages their patients with regard to anemia. As with the hemodialysis adequacy, the hematocrit percentages can be affected by many things -- some of which the facility may be able to control, but not all of them. These factors can include how well the center cares for its patients, but also whether its patients have good health habits outside of the facility. If you have questions about anemia, talk to your doctor or the staff at your dialysis facility.
Quality Measure #3
Expected Survival Rate of the Hemodialysis Center
Another important piece of information you should know about a facility is the "patient survival rate" for that facility. This rates is calculated relative to the expected deaths for a four-year period and is considered a measure of a facility's quality. There are a number of factors that are attributed to the four-year expected survival rates, including age, sex, size, race, ethnicity, whether or not the patients have diabetes, how long the patient has had renal failure and if there was other health problems when the patient started dialysis. The expected number of deaths is calculated in the following manner:
×(the number of years that the patient was treated at the facility)
(The "expected" number of deaths for patients on dialysis)
Expected deaths are calculated for all patients in the facility to a total number of deaths expected for a four-year period at the facility. Many factors can affect the actual patient survival rates at a facility. A facility may be able to control some of these factors, but not others.
Some factors that a facility may be able to control:
- Taking good care of patients, like changing a patient's treatment when necessary, and ensuring the patient is on dialysis for the full treatment time.
- Making sure that its patients get all the treatments prescribed by their doctors
- Teaching patients to take good care of themselves.
Some factors that a facility may not be able to control:
- Whether or not the patient already has other health conditions like heart problems or cancer.
- Unexpected death of a patient. For instance, complications from surgery.
- A patient not following the prescribed treatment. For instance, a patient refusing to finish a dialysis session or not taking medications as prescribed.
When patients first need dialysis, they may have moderate or severe health issues that may or may not improve with adequate dialysis. For this reason, facilities with more new patients may have a higher than expected mortality rate.
If you have a question about a facility's rates, it's important that you discuss it with your doctor or the staff at the dialysis facility. You should contact the facility to find out its most recent patient survival information.