Study shows benefit of Continuous Quality Improvement in treating anemia in dialysis patients

In a study of 250 dialysis patients, researchers at the Rogosin Institute used a Continuous Quality Improvement (CQI) process, aided by an electronic medical record system, to achieve optimal and stable hemoglobin levels with minimum epoetin over an 18-month period, according to research published online in PLOS ONE.

According to the authors, CQI is a process of planning to improve a product or process by analyzing and comparing results against those expected, and taking corrective action on differences between actual and expected results. The process can help understand and contain the effects of variability that stems from the biologic uniqueness of individual patients and their co-morbid conditions, the researchers wrote in the study.

The authors said they used anemia in ESRD patients to test the ability of an electronic medical record, optimized for daily care, to empower CQI in practice. The authors used data collected during daily care that was stored in the EMR and organized to display temporal relationships between clinical, laboratory, and therapeutic events.

According to the authors, these were the highlights of the study:

Hb increased 9% while EPO given decreased 36%
Hb variation decreased 27%
Iron deficiency was rare
New orders for IV iron decreased 40%, for EPO 84%.
Staff time for data review and order writing decreased 50%.
EPO charges decreased 32%; they were $23 below the Medicare bundle allowance.
Mortality was 42% less than the US average.

The researchers said this study validates the hypothesis that an EMR optimized for daily patient care can empower CQI in clinical medicine and serve to monitor medical care quality and cost. The full study is available here.