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FOCUSED CLINICAL CAMPAIGN IMPROVES MINERAL AND BONE DISORDER OUTCOMES. 


Benner, D., Nissenson, A. R. and Van Wyck, D. (2011), FOCUSED CLINICAL CAMPAIGN IMPROVES MINERAL AND BONE DISORDER OUTCOMES. Journal of Renal Care. doi: 10.1111/j.1755-6686.2011.00233.x

What are the main findings of the study?

Eighteen months after initiation of the program, the percent of patients simultaneously meeting all 2003 KDOQI targets for MBD had increased 7% from baseline.

The percent meeting the calcium target increased 24% and the percent meeting the phosphorus target increased 8%.

These findings suggest that a coordinated clinical campaign with interactive tools, outcome tracking and sharing, and team involvement is an effective strategy to improve MBD outcomes and is sustainable over time.

Were any of the findings unexpected?

We knew that few patients at baseline would meet all four targets. 

The targets I’m referring to were the then-current 2003 KDOQI targets for phosphorus, calcium, intact PTH, and Ca × P product.   Only 10% of patients met all four at baseline, and that was consistent with the literature.   

By the end of the intervention, though, 17% percent achieved all four.  Was that unexpected?  Not really.  I would say gratifying. 

This is a result you should expect from a QI intervention that is multi-faceted and interdisciplinary.  

What should clinicians and patients take away from this study?

To our knowledge, this clinical campaign is the first initiative to show the effectiveness of a holistic approach to the three parameters of MBD management with significant increases in patients meeting targets for both calcium and phosphorus.

Importantly, the initiative had four major components:

1) the facility MBD Scorecard,

2) the Physician MBD Management tool,

3) Team Involvement,

and 4) Interactive Education.

So the take-away is that QI initiatives with a holistic design can help improve facility-specific performance in managing MBD outcomes, identify best practices in MBD management, and enhance understanding of leadership and participation within interdisciplinary care teams.

What recommendations do you have for future studies as a result of your study?

We clearly need more research to determine if composite MBD measures, like the MBD Scorecard, are more effective in predicting risk of adverse events than the measures of individual MBD components.  

Even more urgently, we need an interventional trial to determine whether improving MBD laboratory measures in this way directly improves the lives of patients.

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