• Brennan M R Spiegel, Roger Bolus, Amar A Desai, Philip Zager, Tom Parker, John Moran, Sally Bolus, Matthew D Solomon, Osman Khawar, Matthew Gitlin, Hack Sul, Jennifer Talley, and Allen Nissenson.
• Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. bspiegel@mednet.ucla.edu
• Am. J. Kidney Dis. 2010 Jul 1; 56 (1): 86-94.

BackgroundBecause there is wide variation in outcomes across dialysis facilities, it is possible that top-performing units use practices not shared by others. The Identifying Best Practices in Dialysis (IBPiD) Study seeks to identify practices that distinguish top- from bottom-performing facilities by key outcomes, including achievement of recommended hemoglobin targets.Study DesignObservational study with cross-sectional study ascertainment of predictors and outcomes.PredictorsFacility dialysis practices ascertained using practice surveys of dialysis staff who indicated their level of agreement that each practice occurs in their facility (1-6 on a Likert scale).Setting & Participants423 personnel in 90 dialysis facilities from 1 for-profit and 2 not-for-profit dialysis organizations.OutcomesPercentage of patients per month per facility with hemoglobin levels of 11-12 g/dL. We divided facilities by median into top- versus bottom-performing groups and compared mean scores for each practice using t tests. We report practices that were statistically significant and achieved at least a medium effect size (ES) >or=0.4.Results17 of 155 tested predictors were significant. Achievement of hemoglobin level targets was related most strongly to the use of chairside computers (ES, 0.8 [95% CI, 0.4-1.4]), extent/quality of educational videos (ES, 0.6 [95% CI, 0.2-1.1]), frequency of calling per diem staff if short staffed (ES, 0.6 [95% CI, 0.21-1.1]), policy that nurses pass written competency examinations before hire (ES, 0.6 [95% CI, 0.2-1.0]), and technician cannulation mastery (ES, 0.6 [95% CI, 0.2-1.1]).LimitationsThis is a cross-sectional study that can address only associations, not causations. Future research should measure the longitudinal predictive value of these practices.ConclusionsHigh-performing facilities report more effective education programs, better staff management, higher staff competency, and higher use of chairside computers, a potential marker of information technology proficiency. This suggests that hemoglobin level management is enhanced by processes reflecting a coordinated multidisciplinary environment.

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