A practice-related risk score (PRS): a DOPPS-derived aggregate quality index for haemodialysis facilities

Nephrol Dial Transplant. 2008 Oct;23(10):3227-33. doi: 10.1093/ndt/gfn195. Epub 2008 Apr 18.


Background: The Dialysis Outcomes and Practice Patterns Study (DOPPS) database was used to develop and validate a practice-related risk score (PRS) based on modifiable practices to help facilities assess potential areas for improving patient care.

Methods: Relative risks (RRs) from a multivariable Cox mortality model, based on observational haemodialysis (HD) patient data from DOPPS I (1996-2001, seven countries), were used. The four practices were the percent of patients with Kt/V > or =1.2, haemoglobin > or =11 g/dl (110 g/l), albumin > or =4.0 g/dl (40g/l) and catheter use, and were significantly related to mortality when modelled together. DOPPS II data (2002-2004, 12 countries) were used to evaluate the relationship between PRS and mortality risk using Cox regression.

Results: For facilities in DOPPS I and II, changes in PRS over time were significantly correlated with changes in the standardized mortality ratio (SMR). The PRS ranged from 1.0 to 2.1. Overall, the adjusted RR of death was 1.05 per 0.1 points higher PRS (P < 0.0001). For facilities in both DOPPS I and II (N = 119), a 0.2 decrease in PRS was associated with a 0.19 decrease in SMR (P = 0.005). On average, facilities that improved PRS practices showed significantly reduced mortality over the same time frame.

Conclusions: The PRS assesses modifiable HD practices that are linked to improved patient survival. Further refinements might lead to improvements in the PRS and will address regional variations in the PRS/mortality relationship.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Ambulatory Care Facilities / standards*
  • Ambulatory Care Facilities / statistics & numerical data
  • Databases, Factual
  • Humans
  • Kidney Failure, Chronic / therapy
  • Proportional Hazards Models
  • Quality Assurance, Health Care / statistics & numerical data
  • Renal Dialysis / mortality
  • Renal Dialysis / standards*
  • Renal Dialysis / statistics & numerical data
  • Risk Assessment