Continuous quality improvement in daily clinical practice: a proof of concept study.

Continuous Quality Improvement (CQI) is an iterative process of: planning to improve a product or process, plan implementation, analyzing and comparing results against those expected, and corrective action on differences between actual and expected results. It is little used in clinical medicine. Anemia, a complex problem in End Stage Renal Disease patients, served to test the ability of an unique electronic medical record (EMR) optimized for daily care to empower CQI in practice.

Perpetuating sub-optimal care: CMS, QIPs, and the hemoglobin myth.

As the new Centers for Medicare & Medicaid Services' Quality Incentive Program takes effect, the implications are enormous for dialysis patients. Contrary to its intention, the Quality Incentive Program, with its upper hemoglobin limit, may well stifle innovative practice-based research and practical approaches to anemia management. An opportunity to move away from an excessive preoccupation with ESAs to substantially improve patient outcomes, and to do so at a much lower cost, may well be lost to patients, providers, and CMS as a result.

The importance of iron in long-term survival of maintenance hemodialysis patients treated with epoetin-alfa and intravenous iron: analysis of 9.5 years of prospectively collected data.

Background: In patients treated by maintenance hemodialysis the relationship to survival of hemoglobin level and administered epoetin-alfa and intravenous iron is controversial. The study aim was to determine effects on patient survival of administered epoetin-alfa and intravenous iron, and of hemoglobin and variables related to iron status.

Methods: The patients were 1774 treated by maintenance hemodialysis in 3 dialysis units in New York, NY from January 1998 to June, 2007.

Effect of electronic patient record use on mortality in End Stage Renal Disease, a model chronic disease: retrospective analysis of 9 years of prospectively collected data.

Background: In chronic disease, health information technology promises but has yet to demonstrate improved outcomes and decreased costs. The main aim of the study was to determine the effects on mortality and cost of an electronic patient record used in daily patient care in a model chronic disease, End Stage Renal Disease, treated by chronic maintenance hemodialysis. Dialysis treatment is highly regulated, and near uniform in treatment modalities and drugs used.