update rich-q advisory board meeting october 2011
TRANSCRIPT
Update RICH-Q
Advisory Board MeetingOctober 2011
RICH-Q 1 → RICH-Q 2
-Goals and achievements
-Publications
-Current number of patients
Goals RICH-Q 1
• To establish the current quality of care in children with ESRD in the Netherlands and Belgium
• To increase the quality of care of children with ESRD by frequent peer review and discussions of local outcomes
• To build up a comprehensive database on treatment characteristics and outcomes in order to conduct prospective outcomes studies
• To foster clinical studies
Achieved• Database and website • Survey of treatment policies • Advisory board meetings (8) • 11 centers: Cologne • Consensus meetings of quality indicators/ benchmarks • 2SR’s
management of children with ESRDPWV measurement instruments.
• Assessment of the reproducibility and validity of PWV and echocardiogram measurements
• Add-on studies• Study groups • Several presentations • Papers
What have we learned? (1)
• Important differences in dialysis policies:
- between centres
- between policy and actual care
• 17 guidelines, 369 recommendations
only 6% evidence based
• Immigrants
- Tx: less pre-emptive and living donor
higher risk for acute rejection
- Dialysis: more HD (less PD)
longer HD, more ROD, more peritonitis
• Pulse Wave Velocity
– Smallest Detectable Change 1.05 m/s
• Echocardiogram
– low agreement diagnosis LVH
– Smallest Detectable Change 1.6 mm
• Tissue doppler: more detection of DD compared to conventional echocardiogram
What have we learned? (2)
Not yet achieved
• Change in QoC – (guideline implementation and benchmarks)
• Useful outcome measures
• Continuation of the add-on studies
• Publications
Accepted • Comparison of two instruments measuring carotid-femoral pulse
wave velocity: Vicorder versus SphygmoCor JoH
• Lessons learned from efforts to improve the quality of care in children with end-stage renal disease in the Netherlands and Belgium. ADC
• Important differences in management policies for children with end-stage renal disease in the Netherlands and Belgium – Report from the RICH-Q study. NDT
• Less pre-emptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children. NDT
Submitted
• Scope and foundation of current guidelines for the management of chronic dialysis in children; a systematic review : a systematic review. NDT
• Reproducibility of pulse wave velocity measurement in children with end-stage renal disease. Ped Neph
• Chronic dialysis treatment and outcomes differ between immigrant and native Dutch and Belgian children. Ped Neph
• Clinimetric characteristics of instruments that measure pulse wave velocity in adults and children are poorly reported: a systematic review. J. Clin epi.
In progress• Low agreement between cardiologists diagnosing LVH in
children with ESRD
• Does Tissue Doppler measurement lead to earlier detection of diastolic dysfunction in children with ESRD than conventional ultrasound measurement of E/A ratio?
• Important differences in management policies for renal transplantation in children in the Netherlands and Belgium -Report from the RICH-Q study
• The RICH-Q effect of 4 years feedback of care information, peer discussion and guideline development on standard of care in centres for RRT in children
• Quality of life in Dutch and Belgian children with End Stage Renal Disease
Current number of patients
Therapy at start RICHQ
Total: 230
HD: 77PD: 105
TX: 48
Total: 260
HD: 91
PD: 114
TX: 55
Current therapy
Total: 215
HD: 32
PD: 40
TX: 143
Outflow (n=45)
• Deceased: 6• - Primary disease (2): Complications of cong. heart disease
operation, - Wilmstumor with metastasis,
- Secondary disease (4):
Pulmonary hypertension, - Postoperative complication after changing a hemodialysis catheter (no autopsy),
-2x Respiratory insufficiency (1x no informed consent)
• Adult care: 34• No informed consent: 3• Pre emptive Tx failure without cRRT: 1
• Moved: 1
Patients missing? Year of inclusion
Centre
Data entry delay
Measurements points: 141 missing
• HD: 36• PD: 58• Tx (without M0 and M3) : 47
NfN indicators
(dialysis)
RICH-Q website
<11 g/dl
Thesis of Marieke Tromp
• Manuscript? Adres
Friday 25 nov. 2011• Thesis defence and reception:
12.00, Amsterdam.
• Party 21.00, Amsterdam
Thank you gift
RICH-Q Book.
- pictures/ stories/ drawings from children/ personal note/ etc…
- Please email me your personal message to Marieke before November 1th.