TY - JOUR
T1 - Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets
AU - Plantinga, Laura C.
AU - Jaar, Bernard G.
AU - Fink, Nancy E.
AU - Sadler, John H.
AU - Levin, Nathan W.
AU - Coresh, Josef
AU - Klag, Michael J.
AU - Powe, Neil R.
N1 - Funding Information:
We thank the patients, staff, and medical directors of the participating clinics at Dialysis Clinics Inc. and St. Raphael’s Hospital who contributed to the study. This work was supported by grant RO1 DK 59616 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); grant R01HS08365 from the Agency for Health Care Research and Quality; grant R01 HL 62985 from the National
Funding Information:
Heart Lung and Blood Institute, Bethesda, MD; grants K24DK02643 (N.R.P.) and K24 DK02856 (M.J.K.) from the NIDDK; and a Clinician Scientist Award from the Johns Hopkins School of Medicine (B.G.J.). This work was presented in part at the American Society of Nephrology Annual Meeting in St Louis, Missouri, in October 2004.
PY - 2005/4
Y1 - 2005/4
N2 - Objective. To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients. Design. Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years. Setting. 76 not-for-profit US dialysis clinics. Study participants. 678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey. Main outcome measures. Achievement of accepted 6 month clinical performance targets of albumin (≥3.5 g/dl), calcium-phosphate (Ca-P) product (<60 mg2/dl2), dialysis dose (Kt/V ≥ 1.2), vascular access type (fistula), and hemoglobin (≥11 g/dl). Results. By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR) = 0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR = 0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR = 0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR = 0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR = 1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR = 1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR = 0.43, 95% CI, 0.20-0.94). Conclusions. More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.
AB - Objective. To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients. Design. Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years. Setting. 76 not-for-profit US dialysis clinics. Study participants. 678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey. Main outcome measures. Achievement of accepted 6 month clinical performance targets of albumin (≥3.5 g/dl), calcium-phosphate (Ca-P) product (<60 mg2/dl2), dialysis dose (Kt/V ≥ 1.2), vascular access type (fistula), and hemoglobin (≥11 g/dl). Results. By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR) = 0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR = 0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR = 0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR = 0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR = 1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR = 1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR = 0.43, 95% CI, 0.20-0.94). Conclusions. More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.
KW - Chronic kidney disease
KW - Clinical performance
KW - Patient outcomes
KW - Patient-physician contact
KW - Quality of care
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U2 - 10.1093/intqhc/mzi010
DO - 10.1093/intqhc/mzi010
M3 - Article
C2 - 15723821
AN - SCOPUS:16844378213
SN - 1353-4505
VL - 17
SP - 115
EP - 121
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 2
ER -