BACKGROUND: Anemia management in hemodialysis patients poses significant challenges. The present study explored the hypothesis that computerized dosing of intravenous erythropoietin (EPO) would increase the percentage of hemoglobin (Hb) values within the target range and reduce staff time spent on anemia management. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: In-center hemodialysis patients who received EPO at Dialysis Clinic Inc dialysis units for at least 3 months between October 1, 2005, and April 30, 2006. QUALITY IMPROVEMENT PLAN: Computerized decision support (CDS) for EPO dosing is compared with manual physician-directed dosing. OUTCOMES: Achieved monthly Hb values, quantity of EPO administered, and time spent by dialysis unit personnel. MEASUREMENTS: Monthly Hb and quantity of EPO administered to 1,118 patients from 18 dialysis units treated using CDS and 7,823 patients from 125 dialysis units treated using manual dosing. RESULTS: There was no difference in the likelihood of a monthly Hb level of 11-12 or 10-12 g/dL using CDS compared with manual dosing. The likelihood of an Hb level > 12 g/dL decreased and the likelihood of an Hb level < 10 g/dL increased using CDS. EPO use was 4% lower using CDS, although the difference was not statistically significant. CDS was associated with a nearly 50% decrease (P < 0.001) in the time spent by dialysis unit staff on anemia management. LIMITATIONS: Retrospective and nonrandomized. CONCLUSION: The number of monthly Hb values in an 11- (and 10-) to 12-g/dL target range and EPO use did not differ with EPO dosing using CDS compared with manual dosing. Staff resources devoted to anemia management decreased significantly using CDS.
BACKGROUND:Anemia management in hemodialysis patients poses significant challenges. The present study explored the hypothesis that computerized dosing of intravenous erythropoietin (EPO) would increase the percentage of hemoglobin (Hb) values within the target range and reduce staff time spent on anemia management. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: In-center hemodialysis patients who received EPO at Dialysis Clinic Inc dialysis units for at least 3 months between October 1, 2005, and April 30, 2006. QUALITY IMPROVEMENT PLAN: Computerized decision support (CDS) for EPO dosing is compared with manual physician-directed dosing. OUTCOMES: Achieved monthly Hb values, quantity of EPO administered, and time spent by dialysis unit personnel. MEASUREMENTS: Monthly Hb and quantity of EPO administered to 1,118 patients from 18 dialysis units treated using CDS and 7,823 patients from 125 dialysis units treated using manual dosing. RESULTS: There was no difference in the likelihood of a monthly Hb level of 11-12 or 10-12 g/dL using CDS compared with manual dosing. The likelihood of an Hb level > 12 g/dL decreased and the likelihood of an Hb level < 10 g/dL increased using CDS. EPO use was 4% lower using CDS, although the difference was not statistically significant. CDS was associated with a nearly 50% decrease (P < 0.001) in the time spent by dialysis unit staff on anemia management. LIMITATIONS: Retrospective and nonrandomized. CONCLUSION: The number of monthly Hb values in an 11- (and 10-) to 12-g/dL target range and EPO use did not differ with EPO dosing using CDS compared with manual dosing. Staff resources devoted to anemia management decreased significantly using CDS.
Authors: Gilad J Kuperman; Anne Bobb; Thomas H Payne; Anthony J Avery; Tejal K Gandhi; Gerard Burns; David C Classen; David W Bates Journal: J Am Med Inform Assoc Date: 2006-10-26 Impact factor: 4.497
Authors: Yonatan S Spolter; Stephen L Seliger; Min Zhan; Van Doren Hsu; Lori D Walker; Jeffrey C Fink Journal: Am J Kidney Dis Date: 2007-11 Impact factor: 8.860
Authors: José David Martín-Guerrero; Gustavo Camps-Valls; Emilio Soria-Olivas; Antonio José Serrano-López; Juan José Pérez-Ruixo; Nicolas Víctor Jiménez-Torres Journal: IEEE Trans Biomed Eng Date: 2003-10 Impact factor: 4.538
Authors: L Ebony Boulware; Navdeep Tangri; Patti L Ephraim; Julia J Scialla; Stephen M Sozio; Deidra C Crews; Tariq Shafi; Dana C Miskulin; Jiannong Liu; Wendy St Peter; Bernard G Jaar; Albert W Wu; Neil R Powe; Sankar D Navaneethan; Karen Bandeen-Roche Journal: BMC Nephrol Date: 2012-12-06 Impact factor: 2.388
Authors: Aimee Jones; Lana J Mitchell; Rochelle O'Connor; Megan E Rollo; Katherine Slater; Lauren T Williams; Lauren Ball Journal: J Med Internet Res Date: 2018-10-15 Impact factor: 5.428
Authors: Dana C Miskulin; Jing Zhou; Navdeep Tangri; Karen Bandeen-Roche; Courtney Cook; Patti L Ephraim; Deidra C Crews; Julia J Scialla; Stephen M Sozio; Tariq Shafi; Bernard G Jaar; L Ebony Boulware Journal: BMC Nephrol Date: 2013-12-01 Impact factor: 2.388
Authors: Carlo Barbieri; Elena Bolzoni; Flavio Mari; Isabella Cattinelli; Francesco Bellocchio; José D Martin; Claudia Amato; Andrea Stopper; Emanuele Gatti; Iain C Macdougall; Stefano Stuard; Bernard Canaud Journal: PLoS One Date: 2016-03-03 Impact factor: 3.240