DOPPS Practice Monitor Web Site Issues First Update
The Arbor Research Collaborative for Health of Ann Arbor has released its first update of the Dialysis Outcomes and Practice Patterns Study Practice Monitor, a public Web site created to identify current trends and shifts in clinical care as the new prospective payment system for dialysis services takes effect.
The Web site is available at www.dopps.org/DPM.
The PPS, launched in January, is an initiative of the Centers for Medicare & Medicaid Services, as is the upcoming Quality Incentive Program, which begins in 2012. The PPS and QIP are intended to control dialysis costs through, respectively, bundled payments and financial incentives for quality care. Data collected by the DPM will track adjustments in practice and outcomes as clinicians respond to the new systems.
DPM reports are based on data from over 140 dialysis facilities and describe trends covering many different clinical aspects of hemodialysis practice across the country. The April 2011 website update includes data through December 2010, prior to implementation of the bundle. The following preliminary trends through December 2010 were identified:
* Anemia – A small drop in hemoglobin was observed (the three-month decline in mean value from July to December 2010 was 0.06 g/dL). Use of subcutaneous erythropoietin-stimulating agents remained very low. There was an increase in the percentage of patients receiving intravenous (IV) iron and receiving higher IV iron doses. Average ferritin levels were somewhat higher, with fewer patients having low ferritin levels.
* Mineral bone disorder – No changes were seen in serum calcium and phosphorus levels; there was a small rise in mean parathyroid hormone, as well as in the percentage of patients with high PTH values. Overall use of IV vitamin D receptor analogs remained stable. There was a notable increase in doxercalciferol use over the fourth quarter of 2010, along with a reduction in paricalcitol use. No clear change in phosphate binder regimens or cinacalcet use was seen.
* Other areas – No notable trends in demographic characteristics or comorbidities were observed.
These DPM data from late 2010 provide important baseline information, offering the opportunity to identify trends in care from before to after implementation of the bundle. The trends seen through late 2010 indicate that some practices changed in anticipation of the bundle this year, though the magnitude of change in 2010 was small overall. The next major DPM update is scheduled for August 2011 and will report data from January through April 2011, providing a first look at detailed trends in dialysis care after bundle implementation.
The DPM website presents information about demographics, comorbidities, anemia practices, bone and mineral practices, dialysis prescription and dose, cardiovascular medication use, nutrition-related practice, quality of life, and vascular access use. Presenting these data in the form of more than 1,500 regularly updated charts, figures, and data tables, the DPM provides comparisons and trends over time in each of these practice areas for the United States as a whole and soon by facility types. Ongoing trend analysis will help identify significant changes in practice.
The DOPPS is a prospective cohort study investigating practices related to the best outcomes for hemodialysis patients in 12 countries. Administered by the nonprofit Arbor Research Collaborative for Health of Ann Arbor, the DOPPS is supported by scientific grants from Amgen (since 1996), Kyowa Hakko Kirin (since 1999, in Japan), Genzyme (since 2009), Abbott (since 2009), and Baxter (since 2011), without restrictions on publications.
The DOPPS is based on patient- and facility-level data reported from nationally representative samples of facilities within each country. The DPM facility sample is nationally representative, based upon recent comparison with national data. A research paper describing the DPM methods was recently published by the American Journal of Kidney Diseases.
