EFFECT OF PATIENT- AND CENTRE-LEVEL FACTORS ON NEPHROLOGY QUALITY INDICATORS IN AUSTRALIA AND NEW ZEALAND
Adam Steinberg1,2, CHRIS DAVIES3,4, NIGEL TOUSSAINT1,2, STEPHEN MCDONALD3,4,5 1Department of Nephrology, The Royal Melbourne Hospital, 2Department of Medicine(RMH), The University of Melbourne, 3Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 4University of Adelaide, 5Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital,
Abstract
Background
The Australian and New Zealand Society of Nephrology (ANZSN) established a quality indicator (QI) program aimed to measure performance and reduce variation of nephrology care across Australia and New Zealand. This QI program relies on registry data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). ANZDATA also conducts surveys to ascertain more granular characteristics of participating nephrology units to better understand variation in practice.
Aim
To use ANZDATA and the nephrology unit surveys to determine patient- and centre-level factors that may account for variation in nephrology care across the ANZSN/ANZDATA QIs.
Method
QIs were applied to five years of ANZDATA (2016-2020). Various patient characteristics were derived from the same period and dataset. Centre characteristics were determined from the 2019-unit survey. Statistical analysis performed by Stata involved multivariable regression using random effect by centre with year as a fixed effect and backwards elimination.
Results
Wide variation was seen across dialysis access and transplantation QIs. State based variation exists however centre-level variables included from the unit characteristic survey did not account for much of this variation. Whilst patient-level characteristics accounted for some of the variation seen, evidence of unexplained centre-level variation remains.
Conclusion
Future surveys assessing nephrology unit characteristic should include other structural or process characteristics to better understand centre-level variation across units in Australia and New Zealand. This understanding is crucial from a quality improvement perspective.
Biography
Adam in a nephrologist and general physician at The Royal Melbourne Hospital where he is also the Deputy Director of Physician Education. Adam teaches clinical skills and professional practice to medical students at The University of Melbourne where he is also undertaking a PhD looking at quality indicators in the practice of nephrology across Australia and New Zealand. His clinical interests include chronic kidney disease care and education, shared decision making, communication and supportive care. Adam is the chair of young ANZSN and a board member at Stand Up.