Attainment of clinical performance targets and improvement in clinical outcomes and resource use in hemodialysis care: a prospective cohort study

BACKGROUND: Clinical performance targets are intended to improve patient outcomes in chronic disease through quality improvement, but evidence of an association between multiple target attainment and patient outcomes in routine clinical practice is often lacking. METHODS: In a national prospective cohort study (ESRD Quality, or EQUAL), we examined whether attainment of multiple targets in 668 incident hemodialysis patients from 74 U.S. not-for-profit dialysis clinics was associated with better outcomes. We measured whether the following accepted clinical performance targets were met at 6 months after study enrollment: albumin (≥4.0 g/dl), hemoglobin (≥11 g/dl), calcium-phosphate product (<55 mg(2)/dl(2)), dialysis dose (Kt/V≥1.2), and vascular access type (fistula). Outcomes included mortality, hospital admissions, hospital days, and hospital costs. RESULTS: Attainment of each of the five targets was associated individually with better outcomes; e.g., patients who attained the albumin target had decreased mortality [relative hazard (RH) = 0.55, 95% confidence interval (CI), 0.41–0.75], hospital admissions [incidence rate ratio (IRR) = 0.67, 95% CI, 0.62–0.73], hospital days (IRR = 0.61, 95% CI, 0.58–0.63), and hospital costs (average annual cost reduction = $3,282, P = 0.002), relative to those who did not. Increasing numbers of targets attained were also associated, in a graded fashion, with decreased mortality (P = 0.030), fewer hospital admissions and days (P < 0.001 for both), and lower costs (P = 0.029); these trends remained statistically significant for all outcomes after adjustment (P < 0.001), except cost, which was marginally significant (P = 0.052). CONCLUSION: Attainment of more clinical performance targets, regardless of which targets, was strongly associated with decreased mortality, hospital admissions, and resource use in hemodialysis patients

Long-term effects of a non-intensive weight program on body mass index and metabolic abnormalities of obese children and adolescents

<p>Abstract</p> <p>Background</p> <p>Previous studies have demonstrated positive effects of short-term, intensive weight-loss programs in obese children.</p> <p>Objectives</p> <p>We evaluated the long-term effects of a non-intensive weight management program on the BMI, glycemic measures and lipid profiles of obese youth.</p> <p>Methods</p> <p>Retrospective chart review of 61 obese children followed at our Weight Management Center. During visits, dietary changes and regular physical activity were recommended. Anthropometric and laboratory parameters were evaluated.</p> <p>Results</p> <p>At the initial visit, the mean age was 11.1 ± 2.6 years. The follow-up period was 47.3 ± 11.1 months; the number of outpatient visits per year (OV/yr) was 2.9 ± 0.9. At the end of the follow-up, the whole group exhibited decreased BMI z-score and LDL-cholesterol when compared to the initial visit. In the subset of subjects in whom OGTT was performed, 2-hour glucose and peak insulin were decreased. Compared to children with ≤ 2 OV/year, those with > 2 OV/year (3.19 ± 0.7) exhibited a significant decrease in their BMI z-score, LDL-cholesterol, 2-hour glucose, and peak insulin.</p> <p>Conclusions</p> <p>Our study suggests that a periodical (~ 3 OV/yr) evaluation in a non-intensive, long-term weight management program may significantly improve the degree of obesity and cardiovascular risk factors in childhood.</p