Tuesday, April 6, 2010

Its official: Dialysis centers can make a difference

At a recently held Renal Physicians Conference at Baltimore in the US, Dr. Allen Nissenson spoke about an interesting study done at University of California, Los Angeles. Gary Peterson of Renal Web says: "They found that you can take two facilities with the same case mix, Kt/V, time on dialysis, albumin levels, etc – all the usual biochemical and treatment measurements – and the outcomes can still vary as much as 39% In the past, it was reported that they were looking at over 150 variables such as personnel issues, communication patterns, patient education, facility environment, staff morale, etc. to explain these differences."

This is very significant. This means that dialysis units actually have a large role to play in outcomes of dialysis patients. While this might seem obvious at first sight, it is important to realize what they are saying. Apart from the medical basics like proper sterile techniques and actual dialysis procedures, they are now including things like personnel issues, communication patterns, patient education, facility environment and staff morale.

Units where patients are better educated, where the ambience is more cheerful and the staff is more positive lead to better outcomes. Dialysis units must take serious note of this. (That is, of course, if they want better outcomes! How many units in India are seriously concerned about outcomes? Death on dialysis is something that our dear friends have become so used to that not a hair on their heads is stirred when it happens. Sad, but true.)

Managements of dialysis units must strive to make their units more cheerful places. The staff must be trained to make the experience of patients more pleasant. This must be a part of staff reviews and appraisals.

Which leads me to think - why can't someone have a system of rating dialysis units? First, establish a registry of dialysis units in India. Make the units record the statistics of every dialysis session. Keep a detailed history of every dialysis patient. Then, a central agency evaluates the statistics every year and notes how dialysis patients are doing. They publish the ratings of the units. This will give the units an incentive to do better. There will be healthy competition between units for better patient outcomes. They will strive to improve.

Who will benefit the most from this exercise? Of course, the patient!

2 comments:

Madras Hash said...

The rating is best done by an NGO. Since dialysis units are all over the place, the NGO should be a virtual one with members from every possible town.

Given a template for reporting - that can help provide accurate, objective and useful info - people can periodically fill it up and update the database. The important thing is to have a well designed form - probably already done somewhere in the world - and authentic and sensible users filling in and sending in the report. We do not want Dialysis Shops creating dummy patients and ids to boost their ratings.

Kamal: Why don't you & a few other start this NGO?

Kamal D Shah said...

I agree that the rating is best done by an NGO. I am not sure if I have the wherewithal to start this however.