Editor's note: This article originally credited the Kidney Care Partners' Performance Excellence and Accountability in Kidney Care (PEAK) quality improvement initiative for the drop in mortality rate. While a drop in mortality has been confirmed, it has not been confirmed that the drop was a result of the PEAK iniiative.
Dialysis clinics in the United States showed a 13% drop in first-year mortality during Kidney Care Partners' Performance Excellence and Accountability in Kidney Care (PEAK) quality improvement initiative, along with a 25% reduction in mortality for the first 90 days of dialysis treatment, according to an analysis of the PEAK program prepared by Brown University.
The analysis uses a methodology that closely mirrors that by the United States Renal Data System to calculate the mortality rates based on “per person years.” Using an alternative methodology sometimes presented in the literature of “percent of patients dying,” the PEAK results show a 13.7% reduction in first-year mortality and a 22.5% reduction in 90-day mortality.
Launched in 2009, the PEAK Campaign is an initiative designed to highlight proven practices with the goal of improving the rate of survival of kidney failure patients new to dialysis. Available data at the time indicated that overall survival rates for patients with end-stage renal disease had been improving, but, by comparison, the first-year mortality rate had remained relatively stagnant.
As part of the campaign, KCP worked with Quality Partners of Rhode Island (now Heathcentric Advisors) to convene a series of expert panels to focus on clinical as well as patient and family engagement "best practices" that, if implemented consistently, could help improve survival rates. Areas of focus included reducing catheter use in favor of arteriovenous fistulas, improving cardiovascular outcomes, managing nutrition and inflammation, handling anemia, and optimizing dialysis, along with screening for depression, educating patients, and providing social support.
To monitor the kidney care community's efforts to improve first-year survival rates, KCP partnered with researchers at Brown University who analyzed government data sets that include information on patient deaths. Researchers from within the kidney care community worked with Brown researchers on a technical advisory panel to help interpret the data.
“The reduction in first-year mortality represents a significant quality achievement," said Dr. Vincent Mor, the Florence Pirce Grant Professor of Community Health in the Public Health Program of the Brown University School of Medicine. “A reduction of 13.6% in first-year mortality and 25% in 90-day mortality is quite substantial. It's impressive that the kidney community launched this initiative voluntarily and independently. They didn't depend on government to do it for them."