1999 Annual Statistical Report

 

D. 1999 Quality Improvement Activities

1.The Clinical Performance Measures Project

In March 1999 the Clinical Performance Measures (CPM) Project evolved from the Core Indicators Project. The CPM Project is similar to the Core Indicators Project with the addition of measures for assessing vascular access. This project has a consistent clinical database to assess patient outcomes and support improvement activities at Networks 9/10 and facilities. The elements of the database represent clinical measures indicating key components of ESRD patient care. In 1999, all dialysis facilities participated in the Network-wide improvement project. The goals of the project are to:

(1) increase the knowledge and awareness of the CPM Project to Networks 9/10 ESRD providers,

(2) analyze the applicability of the CPMs on facility and network levels,

(3) implement improvement intervention programs on a Network-wide level, and,

(4) improve patient outcomes.

The Renal Network established a process to collect, analyze, and provide data feedback reports to facilities. In the Network–wide CPM project, facilities collected data on 100% of prevalent patients and electronically submitted this to the Network for analysis. There were three hemodialysis (HD) collections: April, July and fourth quarter 1999. Peritoneal dialysis (PD) data was collected in a six-month time frame, November 1998 through April 1999 (N98-A99) and September-December 1999 (S-D99). The data were analyzed and feedback reports were distributed after each collection. The patient demographics and facility participation rates by state and Networks 9/10 are described in Tables D.1 and D.2.

Comparison of HD Outcomes from 4th Quarter 1998 to 4th Quarter 1999

% patients with average URR 65% increased from 76% to 79%

Average URR increased from 69.3% to 69.8%

% patients with average Kt/V Daugirdis II 1.2 increased from 81% to 84%

Average Kt/V Daugirdis II increased from 1.47 to 1.49

Average hemoglobin increased from 11.0 to 11.4 gm/dL

% patients with average hemoglobin 11 gm/dL increased from 58% to 68%

% patients with average hemoglobin between 11-12 gm/dL increased from 51% to 56%

% patients with average hematocrit between 33-36 vol% decreased from 35% to 32%

Average hematocrit increased from 33.9 to 35 vol%

% of patients with average albumin 3.5 gm/dL decreased from 81% to 79%

Average albumin decreased from 3.77 to 3.75 gm/dL

Comparison of PD Outcomes from N97-A98 to N98-A99

% patients with measurement of weekly Creatinine Clearance(CrCl) remained unchanged at 75%

% patients with measurement of weekly Kt/V remained unchanged at 76%

% patients met weekly Kt/V target by modality increased from 62% to 70%

% patient met weekly CrCl target by modality increased from 59% to 64%

% patients with average hematocrit between 33-36 vol% remained unchanged at 32%

Average hematocrit increased from 33.9 to 34.5 vol%

% patients with albumin 3.5 gm/dL increased from 58% to 59%

Average albumin increased from 3.52 to 3.54 gm/dL

Comparison of PD Outcomes from Nov98-Aug99 to Sept 99 – Dec99

% patients with measurement of weekly Creatinine Clearance(CrCl) decreased from 75% to 65%

% patients with measurement of weekly Kt/V increased from 76% to 81%

% patients met weekly Kt/V target by modality increased from 70% to 73%

% patient met weekly CrCl target by modality increased from 64% to 66%

Average hemoglobin increased from 11.42 to 11.67 gm/dL

% patients with average hemoglobin 11 gm/dL increased from 65% to 68%

% patients with average hemoglobin between 11-12 gm/dL decreased from 52% to 48%

% patients with average hematocrit between 33-36 vol% decreased from 32% to 27%

Average hematocrit increased from 34.5 to 35.3 vol%

% patients with albumin 3.5 gm/dL increased from 59% to 60%

Average albumin increased from 3.54 to 3.55 gm/dL

Table D.1. 1999 April, July & 4th Quarter Hemodialysis (HD) Patient Demographics & Facility Participation
Patient

Illinois

Indiana

Kentucky

Ohio

Network 9/10

Demographics Apr July 4Q Apr July 4Q Apr July 4Q Apr July 4Q Apr July 4Q
Total

Number

8935 9205 11067 3895 3962 4911 2203 2250 2887 7297 7717 9783 22331 23134 28658
Sex

Men

Women

52%

48

52%

48

54%

46

52%

48

52%

48

53%

47

52%

48

52%

47

55%

45

52%

48

52%

48

52%

48

52%

48

52%

48

53%

47%

Race

Black

White

Other

46%

47

6

46%

48

6

44%

49

6

34%

63

2

33%

64

2

39%

57

4

31%

67

2

30%

68

1

29%

70

1

42%

55

2

41%

57

2

39%

58

2

41%

55

4

41%

55

4

39%

57

4

Age in years

<18

18-44

45-64

65-74

75+

1%

18

36

26

20

1%

18

35

26

20

*%

17

36

25

22

*%

17

34

28

21

*%

17

34

28

21

1%

16

35

26

21

*%

18

36

26

19

*%

18

37

26

18

1%

17

37

26

18

*%

17

34

28

20

*%

17

34

28

21

1%

15

35

26

22

*%

17

35

27

20

*%

17

35

27

20

1%

16

35

26

21

Primary Dx

DM

HTN

GN

Other

Unknown

35%

36

11

17

*

34%

36

11

18

1

36%

35

10

19

1

37%

30

14

19

*

36%

30

14

20

*

39%

29

12

20

*

40%

25

14

21

*

40%

25

14

21

*

41%

25

13

21

*

41%

24

16

19

*

41%

23

16

20

*

43%

23

14

20

*

38%

30

14

18

*

37%

29

13

19

*

39%

29

12

20

*

% Facility

Participation

100

98

98

98

99

95

100

100

97

99

99

97

99

99

97

*% represents less than one percent. Subgroup total may not add to 100% due to rounding or missing data elements.
 
Table D.2. Nov98 -April99 & Sept99 –Dec99 Peritoneal Dialysis (PD) Patient Demographics & Facility Participation
Patient

Illinois

Indiana

Kentucky

Ohio

Network 9/10

US^

Demographics

N98-

A99

S-D 1999

N98-

A99

S-D 1999

N98-

A99

S-D 1999

N98-

A99

S-D 1999

N98-

A99

S-D 1999

98-99

Total Number

1352

911

1023

745

328

246

1688

1330

4391

3232

1533

Sex

Men

Women

50

50

49

51

48

51

51

49

54

46

56

44

51

49

51

49

50

49

51

49

50

50

Race

Black

White

Other

33

55

12

24

63

13

21

76

2

21

76

3

13

85

1

13

86

1

26

71

3

23

74

3

26

68

5

22

72

6

26

61

13

Age in Years

<18

18-44

45-64

65-74

75+

3

26

40

19

11

4

23

40

20

13

3

25

38

23

11

3

25

41

20

11

1

30

42

17

8

*

26

48

17

9

2

23

43

21

9

3

24

41

21

11

3

25

41

20

10

3

24

41

20

11

^

26

45

29

^

Primary Dx

DM

HTN

GN

Other

Unknown

31

27

20

21

*

31

26

20

23

-

35

25

18

22

-

36

24

18

21

*

37

16

22

25

1

36

17

19

27

*

41

16

20

22

*

42

15

19

24

-

36

22

20

22

-

37

20

19

23

*

33

22

20

26

^

% Facility

Participation

97

88

98

96

97

95

98

98

98

94

^

*% represents less than one percent. ^ U.S. data from HCFA National Core Indicator Project.

Subgroup total may not add to 100% due to rounding or missing data elements.

2. CPM Results.

Three clinical areas are addressed in the HD CPM project. The treatment of anemia includes the first monthly pre-dialysis hemoglobin (HGB), hematocrit (HCT), transferrin saturation (TSAT), serum ferritin concentration and weekly Epogen (Epo) dosage. Adequacy of dialysis contains the first monthly-paired pre/post serum urea nitrogen for a urea reduction ratio (URR) and a calculation of Kt/V using the Daugirdis II methodology. The nutritional status is measured by the serum albumin; bromocresol purple (BCP) assay measurements are adjusted by +0.3 for comparison to the bromocresol green (BCG) measurements.

2.a.Treatment of Anemia - Hemodialysis. Figure D.1. shows the percent of patients with average pre-dialysis HGB 11 gm/dL. Networks 9/10 rates had a statistical increase of 10% between the 4th quarter 1998 and 4th quarter 1999 with state rates ranging from 8%-11%.

Figure D.2. and Table D.3 show the distribution of HGB values for the states, Networks 9/10 and the United States. The average HCT increased from 33.9 in the 4th quarter 1998 to 35.0 in the 4th quarter 1999.

Figure D.3. shows the percent of patients with HCT 31 vol% by state and Networks 9/10. There have been statistical increases each year.

Table D.4. shows the distribution of HCT values for states and Networks 9/10.

Table D.5. compares average and standard deviation values by state for HGB, HCT, TSAT, Ferritin and Epo dose. The more frequent route of Epogen administration was reported as intravenous at 75%. This was an increase of 1% from 4th quarter 1998. The average Epogen dose decreased from 241 units/kilogram/week to 240 units/kilogram/week in 1998. Of the patients who were prescribed iron, 75% were prescribed intravenous iron in the 4th quarter of 1999. Between the 4th quarters of 1997 and 1999, the average TSAT decreased 1% from 29% to 28.0% and the average ferritin increased from 469 ng/mL to 514 ng/mL.

Figures D.4. & D.5.compare TSAT and ferritin between states and Networks 9/10 for the 4th quarters of 1998 and 1999.

Table D.6. shows the percent of patients with paired TSAT <20% and Ferritin <100 ng/mL from 4th quarter 1997-1999.

 
 
 

 
 
 
 
Table D.3. Distribution of HD HGB values (gm/dL) by State.
 

< 9

9 - 10

11 - 12

>12

IL 4Q98

IL 4Q99

8%

6%

37%

28%

48%

57%

7%

10%

IN 4Q98

IN4Q99

5%

4%

33%

25%

54%

58%

8%

14%

KY 4Q98

KY4Q99

8%

6%

35%

28%

52%

55%

5%

11%

OH 4Q98

OH4Q99

7%

4%

35%

29%

52%

56%

6%

11%

 
Table D.4. Distribution of HD HCT values (vol%) by States & Networks 9/10.
 

< 25

25-27

28-30

31-33

34-35

36+

IL 4Q96

IL 4Q97

IL 4Q98

IL 4Q99

5%

4%

3%

2%

10%

8%

6%

5%

19%

19%

14%

10%

32%

31%

27%

22%

18%

22%

23%

22%

17%

15%

27%

38%

IN 4Q96

IN 4Q97

IN 4Q98

IN4Q99

2%

2%

2%

1%

7%

5%

4%

3%

17%

15%

11%

9%

34%

34%

25%

20%

22%

25%

26%

22%

17%

20%

32%

45%

KY 4Q96

KY 4Q97

KY 4Q98

KY4Q99

3%

2%

2%

2%

10%

7%

6%

4%

18%

19%

14%

9%

33%

35%

25%

22%

21%

22%

23%

22%

15%

14%

30%

42%

OH 4Q96

OH 4Q97

OH 4Q98

OH4Q99

3%

3%

2%

1%

8%

6%

5%

3%

18%

17%

13%

9%

32%

35%

28%

20%

21%

24%

23%

22%

18%

15%

29%

44%

Net 9/10 4Q96

Net 9/10 4Q97

Net 9/10 4Q98

Net 9/10 4Q99

4%

3%

2%

2%

9%

7%

5%

4%

18%

18%

13%

10%

32%

33%

27%

21%

20%

23%

24%

22%

17%

16%

29%

42%

 
Table D.5. HD Anemia Management Measures by State and Networks 9/10.
 

Illinois

avg sd

Indiana

avg sd

Kentucky

avg sd

Ohio

avg sd

Net 9/10

avg sd

HGB 4Q98

HGB 4Q99

11.0

11.4

1.6

1.4

11.2

11.6

1.3

1.4

11.0

11.4

1.3

1.4

11.1

11.4

1.3

1.4

11.1

11.4

1.4

1.4

HCT 4Q97

HCT 4Q98

HCT 4Q99

32.8

33.7

34.6

3.8

4.1

4.3

33.3

34.3

35.4

3.7

3.9

4.2

32.7

33.9

35.0

3.7

4.0

4.4

32.8

33.9

35.4

3.6

4.0

4.3

32.8

33.9

35.0

3.8

4.0

4.3

TSAT 4Q97

TSAT 4Q98

TSAT 4Q99

29.0

30.2

29.7

13.9

14.3

13.4

29.5

27.6

27.2

13.3

13.0

12.9

28.5

27.5

26.4

13.7

13.4

12.3

26.7

26.9

26.9

13.0

13.2

12.6

29.0

28.4

28.0

13.9

13.7

13.0

Ferritin 4Q97

Ferritin 4Q98

Ferritin 4Q99

431

459

465

425

430

461

523

534

545

429

462

469

409

436

507

391

400

424

508

516

558

437

421

446

469

489

514

429

431

456

Epo dose

u/kg/wk 4Q97

u/kg/wk 4Q98

u/kg/wk 4Q99

227

250

257

880

200

194

205

220

239

158

180

197

229

241

223

223

191

183

228

243

228

205

193

200

223

241

240

570

194

196

 
Table D.6. Anemia Management Measures for Percent of Patients in 4th Quarter 1997-1999 with Paired TSAT <20% & Ferritin < 100 ng/mL by State and Networks 9/10
 

Illinois

4th Qtr

‘97 ‘98 ‘99

Indiana

4th Qtr

‘97 ‘98 ‘99

Kentucky

4th Qtr

‘97 ’98 ‘99

Ohio

4th Qtr

‘97 ’98 ‘99

Net 9/10

4th Qtr

‘97 ’98 ‘99

TSAT < 20% and

Ferritin <100 ng/ml

10

8

7

6

7

6

12

12

9

6

6

6

8

8

7

 

 
 

 
 

 
 

 
2.b.Treatment of Anemia – Peritoneal Dialysis. Anemia management measures show improvement in each of the reporting cycles.

Figure D.6. shows the percent of patients with average HGB 11 gm/dL for the states and Networks 9/10.

Figure D.7. shows the distribution of PD HGB values for Networks 9/10 and the U.S.

Table D.7. shows the distribution of HGB values for the states. The distribution is shifting to the right, indicating improvements.

Table D.8. shows the distribution of HCT values for the past 4 reporting cycles. The distributions are shifting to the right, indicating improvements.

Table D.9. reports averages and standard deviations of the HGB, HCT, TSAT, Ferritin and EPO dose measurements.

Figures D.8. and D.9. compare the TSAT and Ferritin values by state and Network 9/10 for the periods N98-A99 and S-D99.

Table D.10. shows state comparisons for paired TSAT <20 % and Ferritin <100 ng/mL measures, the Networks 9/10 rate is10%. Iron prescriptions were reported for 2986 patients in N98-A99 and 2118 patients in S-D99, 5% of these patients were reported having an IV iron prescription.

 
 

 
 

 
 

 
 

 
Table D.7. Distribution of PD HGB values (gm/dL) by State.
 

< 9

9-10

11-12

12+

IL N98-A99

IL S-D99

7%

5%

32%

30%

48%

47%

12%

17%

IN N98-A99

IN S-D99

4%

4%

29%

27%

54%

50%

13%

20%

KY N98-A99

KY S-D99

5%

6%

30%

21%

52%

51%

13%

22%

OH N98-A99

OH S-D99

4%

4%

29%

27%

52%

48%

14%

20%

 
Table D.8. Distribution of PD HCT values (vol%) by State
 

< 25

25-27

28-30

31-33

34-35

36+

IL N96-A97

IL N97-A98

IL N98-A99

IL S99-D99

3%

3%

3%

2%

7%

7%

6%

5%

16%

15%

13%

13%

33%

30%

26%

21%

17%

19%

20%

20%

24%

26%

32%

38%

IN N96-A97

IN N97-A98

IN N98-A99

IN S99-D99

3%

2%

2%

2%

7%

5%

3%

3%

15%

12%

12%

11%

28%

26%

24%

22%

19%

23%

22%

16%

29%

32%

38%

45%

KY N96-A97

KY N97-A98

KY N98-A99

KY S99-D99

2%

4%

2%

3%

6%

7%

5%

3%

18%

15%

13%

10%

30%

30%

22%

20%

18%

20%

20%

16%

25%

25%

38%

48%

OH N96-A97

OH N97-A98

OH N98-A99

OH S99-D99

3%

3%

2%

2%

5%

6%

4%

4%

13%

14%

11%

11%

28%

30%

26%

24%

22%

19%

21%

16%

30%

28%

37%

43%

 
Table D.9. PD Anemia Management Measures by State & Networks 9/10.
 

Illinois

avg sd

Indiana

avg sd

Kentucky

avg sd

Ohio

avg sd

Net 9/10

avg sd

HGB N98-A99

HGB S99-D99

11.3

11.6

1.6

1.7

11.5

11.7

1.5

1.6

11.4

11.8

1.4

1.7

11.51

11.7

1.49

1.7

11.42

11.7

1.5

1.7

HCT N96-A97

HCT N97-A98

HCT N98-A99

HCT S99-D99

33.4

33.6

34.1

34.7

4.6

4.7

4.9

4.8

33.9

34.5

34.8

35.5

4.4

4.5

4.4

5.0

33.4

33.4

34.5

35.7

4.3

4.8

4.4

5.3

34.0

33.7

34.7

35.4

4.4

4.5

4.6

5.1

33.8

33.9

34.5

35.3

4.5

4.6

4.7

5.0

TSAT N97-A98

TSAT N98-A99

TSAT S99-D99

29.5

28.2

29.8

14.1

11.6

13.9

28.8

28.5

29.1

12.7

12.5

14.5

27.2

29.0

28.9

13.2

13.9

13.6

26.1

27.0

27.3

11.4

12.2

12.4

27.8

27.9

28.6

12.8

12.3

13.6

Ferritin N97-A98

Ferritin N98-A99

Ferritin S99-D99

347

329

346

404

334

418

420

417

465

462

467

505

301

301

294

399

335

282

354

369

359

380

409

394

363

364

378

411

401

429

Epo Dose

u/kg/wkN96-A97

u/kg/wkN97-A98

u/kg/wk N98-A99

u/kg/wk S99-D99

141

136

145

147

99

120

131

127

148

143

145

147

102

113

131

127

146

145

155

147

92

87

104

114

127

138

134

140

105

190

114

135

137

139

145

147

147

147

131

127

 
Table D.10. Percent of Patient Measurements in November 1997 – April 1998 with

Paired TSAT <20% & Ferritin < 100 ng/mL by State & Networks 9/10.

 

Illinois

Indiana

Kentucky

Ohio

Net 9/10

  N97

A98

N98A99 S-D

99

N97

A98

N98A99 S-D

99

N97

A98

N98A99 S-D

99

N97

A98

N98A99 S-D

99

N97

A98

N98A99 S-D

99

TSAT < 20% and

Ferritin <100 ng/ml

11

9

10

9

7

9

12

13

8

13

8

11

12

9

10

 
2.c. Adequacy of Hemodialysis. Figure D.10. shows the percent of patients with an average URR of 65% or greater by state, Networks 9/10, and by year. There was a 3% increase from 4Q98 to 4Q99.

Figure D.11. shows the percent of patients with an average Kt/V Daugirdis II of 1.2 or greater. There was a 2% increase from one year ago in the Networks 9/10 rate. The 4th quarter 1999 average URR was 69.8% with a standard deviation of 7.6 and the average Kt/V Daugirdis II was 1.49 with a standard deviation of 0.37. The average HD treatment time increased one minute, from 217 to 218.

Table D.11. shows URR, Kt/V Daugirdis II and treatment time averages and standard deviations by state and Networks 9/10.

Figures D.12. and D.13. show the distribution of URR and Kt/V Daugirdis II values for 4th quarter 1996- 1999. The curves shift to the right, which indicates adequacy outcome improvements over time.

 

 
 

 
 

 
 

 
 

 
Table D.11. HD Adequacy Performance Measures by State & Networks 9/10.
 

Illinois

avg sd

Indiana

avg sd

Kentucky

avg sd

Ohio

avg sd

Net 9/10

avg sd

URR 4Q96

URR 4Q97

URR 4Q98

URR 4Q99

66.3

67.1

68.5

69.4

9.2

8.9

8.5

78

68.6

69.4

70.7

70.7

7.9

7.9

7.3

7.6

65.9

68.2

68.4

70.0

9.0

9.4

8.1

7.8

67.3

69.0

69.8

70.1

7.8

7.7

7.4

7.2

67.1

68.2

69.3

69.8

8.5

8.5

7.9

7.6

Kt/V 4Q96

Kt/V 4Q97

Kt/V 4Q98

Kt/V 4Q99

1.32

1.38

1.43

1.48

.35

.37

.36

.38

1.39

1.47

1.52

1.54

.32

.36

.35

.40

1.30

1.41

1.43

1.45

.32

.35

.35

.35

1.34

1.44

1.48

1.50

.28

.34

.36

.37

1.34

1.42

1.47

1.49

.32

.36

.36

.38

Min 4Q96

Min 4Q97

Min 4Q98

Min 4Q99

209

213

217

218

31

28

28

27

209

215

222

221

36

31

30

35

209

212

214

216

32

30

29

30

209

213

216

216

29

29

28

28

209

214

217

218

32

29

29

30

 
2.d. Adequacy of Peritoneal Dialysis. Two collections of PD Clinical Performance Measures were collected in 1999, November 1998 – April 1999 (N98-A99) and September – December 1999 (S-D99). PD adequacy measures were the weekly creatinine clearance (CrCl) and weekly Kt/V. Facilities reported patient measurements in the collection time frames. Measuring CrCl adequacy decreased from 75% to 65% and measuring Kt/V increased from 76% to 81% between the two collections. Figures D.14. and D.15. show the percent of PD patients in Networks 9/10 measured and meeting weekly CrCl and Kt/V DOQI guidelines for three most current reporting cycles. Approximately 40% of the PD population were either not measured or did not meet DOQI guidelines.
 
 

 
 

 
In the 1999 HCFA Annual Report, ESRD Clinical Performance Measures Project, approximately 85% of PD patients in the October 1998-March 1999 national sample had an adequacy measurement. The Networks 9/10 Kt/V measurement rate of 81% is below the national rate for measuring PD patients for adequacy. Improvement areas continue to be in the areas of measuring and adequacy.

Table D.12. shows average CrCl and Kt/V reported by facilities are increasing.

Table D.12. PD Average (avg) and Standard Deviation (sd) Values for Adequacy Measures

by State & Networks 9/10.

 

Illinois

avg sd #pts

Indiana

avg sd #pts

Kentucky

avg sd #pts

Ohio

avg sd #pts

Network 9/10

avg sd #pts

CAPD

CrCl 96-97

CrCl 97-98

CrCl S-D99

67.6

71.9

76.4

25

30

32

305

482

293

65.7

70.3

75.4

23

28

29

464

516

297

75.3

73.1

76.7

30

37

43

122

121

87

69.7

72.4

78.1

24

27

33

635

703

472

68.5

71.7

76.8

24

29

33

1526

1822

1149

CAPD

Kt/V 96-97

Kt/V 97-98

Kt/V S-D99

2.12

2.26

2.36

.55

.55

.58

338

508

297

2.11

2.17

2.27

.54

.53

.56

471

520

298

2.1

2.3

2.2

.57

.69

.59

120

127

85

2.08

2.19

2.27

.60

.57

.56

643

707

466

2.10

2.21

2.29

.57

.56

.57

1572

1862

1146

Cycler

CrCl 96-97

CrCl 97-98

CrCl S-D99

68.3

73.0

74.7

26

28

31

201

367

337

63.4

68.8

84.6

22

24

38

169

254

180

69.6

73.0

75.0

30

36

35

85

112

93

66.9

71.0

77.0

23

26

33

343

422

406

66.8

71.3

77.4

24

27

33

798

1155

1016

Cycler

Kt/V 96-97

Kt/V 97-98

Kt/V S-D99

2.28

2.31

2.36

.56

.57

.57

223

393

345

2.15

2.30

2.62

.66

.60

.65

169

257

179

2.39

2.29

2.40

.77

.61

59

82

111

91

2.18

2.20

2.39

.63

.54

.58

345

401

393

2.22

2.27

2.42

.64

.57

.60

819

1162

1008

 
Figures D.16., D.17., D.18., and D.19. show the percent of CAPD and CCPD patients by state and Networks 9/10 meeting DOQI™ guidelines for adequacy. The trends show improvements. The 95% confidence intervals indicate no difference in the same reporting period, but do indicate differences between different collection time frames.
 
 

 
 

 
 

 
 

 
2.e. Nutritional Status. The serum albumin was measured as a nutritional outcome. 80% of the HD patients had an albumin measured with a bromocresol green (BCG) assay, 4% bromocresol purple (BCP) and 16% were reported with no designated assay. 80% of the PD patients had an albumin measured with a BCG assay, 18% with a BCP assay and 2% were reported with no designated assay. An adjustment of +0.3 was made to serum albumin measured using the BCP assay for comparisons.

Hemodialysis - Albumin. Table D.13. outlines the average and standard deviation values by state, Networks 9/10.The average albumin in the 4th quarter 1999 was 3.75 gm/dL, a slight decrease from 3.77 gm/dL in the 4th quarter 1998. The percent of patients with an average albumin 3.5 gm/dL decreased 2%,(81% to 79%) between the two time periods. 33% of the patients had an average albumin 4.0 gm/dL.

Table D.13. HD Average (avg) and Standard Deviation (sd) Values for Albumin by State & Networks 9&10.
 

Illinois

avg sd

Indiana

avg sd

Kentucky

avg sd

Ohio

avg sd

Network 9/10

avg sd

Albumin 4Q96

Albumin 4Q97

Albumin 4Q98

Albumin 4Q99

3.67

3.76

3.78

3.78

.49

.46

.43

.43

3.74

3.82

3.81

3.79

.40

.45

.42

.51

3.71

3.79

3.78

3.72

.42

.50

.45

.44

3.67

3.78

3.75

3.70

.44

.44

.44

.45

3.69

3.78

3.77

3.75

.45

.46

.44

.46

 
Table D.14. shows the distribution of average albumin by state and Networks 9/10 from 4th quarter 1996-1999.
 
Table D.14. Distribution of Average Albumin Values (gm/dl) by State & Networks 9/10.
 

< 2.0

2.0-2.4

2.5-2.9

3.0-3.4

3.5+

IL 4Q96

IL 4Q97

IL 4Q98

IL 4Q99

0.3%

0.2%

0.1%

0.1%

1.0%

0.8%

0.6%

0.6%

4.2%

3.6%

3.3%

3.3%

18.6%

16.9%

14.0%

15.0%

76.0%

78.7%

82.0%

80.7% (35.7)*

IN 4Q96

IN 4Q97

IN 4Q98

IN 4Q99

0.1%

0.3%

0.1%

0.1%

0.6%

0.5%

0.6%

0.9%

2.4%

2.5%

2.6%

3.3%

15.3%

13.7%

13.9%

15.7%

81.7%

83.1%

82.8%

79.7% (35.2)*

KY 4Q96

KY 4Q97

KY 4Q98

KY 4Q99

0.2%

0.1%

0.2%

0.2%

0.3%

0.7%

0.8%

0.8%

3.7%

2.9%

3.5%

4.0%

14.9%

13.6%

15.9%

16.2%

80.8%

82.6%

79.5%

78.2% (30.4)*

OH 4Q96

OH 4Q97

OH 4Q98

OH 4Q99

0.2%

0.1%

0.2%

0.2%

0.7%

0.8%

0.8%

1.0%

3.5%

3.1%

4.0%

4.9%

16.7%

14.8%

16.2%

17.8%

78.8%

81.0%

78.8%

75.8% (30.0)*

Net 9/10 4Q96

Net 9/10 4Q97

Net 9/10 4Q98

Net 9/10 4Q99

0.2%

0.2%

0.1%

0.2%

0.7%

0.7%

0.7%

0.8%

3.6%

3.2%

3.4%

4.0%

16.9%

15.3%

14.9%

16.2%

78.7%

80.6%

80.8%

78.6% (33.1)*

*The percent of patients with average albumins 4.0 gm/dL are noted in parentheses for 4Q99 only.
 

 
Figure D.20. compares the percent patients with average albumin 3.5 gm/dL by state, Networks 9/10 from 4th quarter 1996-1999.
 

 
Peritoneal Dialysis - Albumin. The Networks 9/10 average albumin for the November 1998- April 1999 and September –December 1999 reporting cycles were 3.54 gm/dL and 3.55 gm/dL, respectively, Table D.15. In these two reporting cycles, the percent of patients in Networks 9/10 with an average albumin 3.5 gm/dl was 59% and 60%.

Table D.16. shows the distribution of average albumin values by state and Networks 9/10. The data shows statistical changes over time and variation between states.

Table D.15. PD Average (avg) and Standard Deviation (sd) Values for Albumin by State & Networks9/10
 

Illinois

avg sd

Indiana

avg sd

Kentucky

avg sd

Ohio

avg sd

Network 9&10

avg sd

Albumin N96-A97

Albumin N97-A98

Albumin N98-A99

Albumin S-D99

3.48

3.52

3.55

3.60

.50

.54

.53

.52

3.50

2.60

3.61

3.61

.50

.52

.55

.50

3.41

3.48

3.53

3.59

.52

.50

.54

.51

3.40

3.49

3.48

3.48

.52

.49

.54

.54

3.44

3.52

3.54

3.55

.51

.52

.54

.53

 
Table D.16. Distribution of Average Albumin Values by State & Networks 9&10
 

< 2.0

2.0-2.4

2.5-2.9

3.0-3.4

3.5+
IL N96-A97

IL N97-A98

IL N98-A99

IL S-D99

0.5%

1.3%

0.4%

0.5%

2.4%

2.7%

2.6%

1.7%

11.7%

8.2%

9.2%

7.9%

30.5%

29.4%

26.6%

24.8%

54.9%

58.4%

60.8% (22.9)*

64.8% (25.0)*

IN N96-A97

IN N97-A98

IN N98-A99

IN S-D99

0.4%

0.5%

0.9%

0.1%

2.5%

1.7%

1.9%

1.6%

9.8%

8.0%

7.6%

7.1%

31.5%

27.2%

23.5%

25.9%

55.9%

62.7%

65.7% (25.9)*

65.0% (23.3)*

KY N96-A97

KY N97-A98

KY N98-A99

KY S-D99

1.2%

0.8%

0.6%

1.2%

3.9%

1.6%
2.8%

1.2%

11.2%

10.3%

8.8%

6.3%

34.4%

33.8%

31.1%

25.6%

49.2%

53.5%

56.4% (20.3)*

65.4% (23.9)*

OH N96-A98

OH N97-A98

OH N98-A99

OH S-D99

0.8%

0.4%

0.7%

0.5%

3.6%

2.1%

2.9%

2.9%

13.6%

10.9%

11.7%

11.8%

33.9%

30.5%

29.7%

34.7%

48.1%

56.1%

54.7%(18.3)*

53.0% (18.3)*

Net 9/10 N96-A97

Net 9/10 N97-A98

Net 9/10 N98-N99

Net 9/10 D-S99

0.6%

0.7%

0.6%

0.5%

3.1%

2.1%

2.6%

2.1%

12.0%

9.4%

9.8%

9.2%

32.6%

29.6%

27.4%

27.8%

51.8%

58.2%

59.2% (21.6)*

60.1% (21.8)*

*The percent of patients with average albumin 4.0 gm/dL are noted in parentheses for N98-A99 and

S-D99 only.

 
Figure D.21. compares the percentage of patients with an average albumin 3.5 gm/dl by state and Networks 9/10 for the 4 most current reporting cycles.

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