{"title":"质量指标和临床结果:护理质量在非糖尿病性慢性肾脏疾病管理中的作用","authors":"Yun-Fang Hsieh, Le-Yin Hsu, Ping-Hsiu Tsai, Wan-Chuan Tsai, Mei-Ju Ko, Kuo-Liong Chien, Hon-Yen Wu","doi":"10.1080/0886022X.2025.2469748","DOIUrl":null,"url":null,"abstract":"<p><p>Quality indicators (QIs) are essential for evaluating healthcare quality, but their validation for nondiabetic chronic kidney disease (CKD) populations is limited. We aimed to assess the association between QIs and outcomes in nondiabetic CKD patients. Using Taiwan's National Health Insurance claims data and death registries, we analyzed 27,842 nondiabetic adults with stage 3B-5 CKD from 2016 to 2019. Three QIs were assessed: renin-angiotensin system (RAS) inhibitor prescription, proteinuria testing, and nonsteroidal anti-inflammatory drug (NSAID) avoidance. Each patient received an overall QI score (range: 0-3) based on the sum of the individual QI scores. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between QI scores and outcomes, including long-term dialysis, all-cause death, hospitalization for acute kidney injury (AKI), hyperkalemia, and acidosis. The study population had a mean age of 68.7 years and a female prevalence of 41.7%. Only 33.5% of patients received the highest QI score. During a median follow-up period of 23 months, higher overall QI scores were associated with lower risks of long-term dialysis (HR 0.891, 95% CI 0.846-0.938), all-cause death (HR 0.900, 95% CI 0.864-0.939), and acidosis (HR 0.882, 95% CI 0.799-0.972). Notably, the prescription of RAS inhibitors was consistently correlated with better outcomes. These findings underscore the importance of quality indicators, particularly the continued use of RAS inhibitors, in improving outcomes for nondiabetic CKD patients. Future research should focus on refining existing QIs and expanding their validation to broader populations and healthcare settings.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2469748"},"PeriodicalIF":3.0000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852228/pdf/","citationCount":"0","resultStr":"{\"title\":\"Quality indicators and clinical outcomes: the role of care quality in nondiabetic chronic kidney disease management.\",\"authors\":\"Yun-Fang Hsieh, Le-Yin Hsu, Ping-Hsiu Tsai, Wan-Chuan Tsai, Mei-Ju Ko, Kuo-Liong Chien, Hon-Yen Wu\",\"doi\":\"10.1080/0886022X.2025.2469748\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Quality indicators (QIs) are essential for evaluating healthcare quality, but their validation for nondiabetic chronic kidney disease (CKD) populations is limited. We aimed to assess the association between QIs and outcomes in nondiabetic CKD patients. Using Taiwan's National Health Insurance claims data and death registries, we analyzed 27,842 nondiabetic adults with stage 3B-5 CKD from 2016 to 2019. Three QIs were assessed: renin-angiotensin system (RAS) inhibitor prescription, proteinuria testing, and nonsteroidal anti-inflammatory drug (NSAID) avoidance. Each patient received an overall QI score (range: 0-3) based on the sum of the individual QI scores. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between QI scores and outcomes, including long-term dialysis, all-cause death, hospitalization for acute kidney injury (AKI), hyperkalemia, and acidosis. The study population had a mean age of 68.7 years and a female prevalence of 41.7%. Only 33.5% of patients received the highest QI score. During a median follow-up period of 23 months, higher overall QI scores were associated with lower risks of long-term dialysis (HR 0.891, 95% CI 0.846-0.938), all-cause death (HR 0.900, 95% CI 0.864-0.939), and acidosis (HR 0.882, 95% CI 0.799-0.972). Notably, the prescription of RAS inhibitors was consistently correlated with better outcomes. These findings underscore the importance of quality indicators, particularly the continued use of RAS inhibitors, in improving outcomes for nondiabetic CKD patients. Future research should focus on refining existing QIs and expanding their validation to broader populations and healthcare settings.</p>\",\"PeriodicalId\":20839,\"journal\":{\"name\":\"Renal Failure\",\"volume\":\"47 1\",\"pages\":\"2469748\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852228/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Renal Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/0886022X.2025.2469748\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Renal Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/0886022X.2025.2469748","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
质量指标(QIs)是评估医疗保健质量的关键,但其在非糖尿病性慢性肾脏疾病(CKD)人群中的有效性有限。我们的目的是评估非糖尿病性CKD患者的QIs与预后之间的关系。评估了三个QIs:肾素-血管紧张素系统(RAS)抑制剂处方、蛋白尿检测和非甾体抗炎药(NSAID)避免。每位患者根据个体QI评分的总和获得整体QI评分(范围:0-3)。使用Cox比例风险模型来估计QI评分与结局(包括长期透析、全因死亡、急性肾损伤住院、高钾血症和酸中毒)之间关联的风险比(hr)和95%置信区间(CIs)。研究人群的平均年龄为68.7岁,女性患病率为41.7%。只有33.5%的患者获得最高的QI评分。在中位随访23个月期间,总体QI评分越高,长期透析(HR 0.891, 95% CI 0.846-0.938)、全因死亡(HR 0.900, 95% CI 0.864-0.939)和酸中毒(HR 0.882, 95% CI 0.799-0.972)的风险越低。值得注意的是,RAS抑制剂的处方始终与更好的结果相关。这些发现强调了质量指标的重要性,特别是RAS抑制剂的持续使用,在改善非糖尿病性CKD患者的预后方面。未来的研究应侧重于完善现有的质量指标,并将其验证扩展到更广泛的人群和医疗保健环境。
Quality indicators and clinical outcomes: the role of care quality in nondiabetic chronic kidney disease management.
Quality indicators (QIs) are essential for evaluating healthcare quality, but their validation for nondiabetic chronic kidney disease (CKD) populations is limited. We aimed to assess the association between QIs and outcomes in nondiabetic CKD patients. Using Taiwan's National Health Insurance claims data and death registries, we analyzed 27,842 nondiabetic adults with stage 3B-5 CKD from 2016 to 2019. Three QIs were assessed: renin-angiotensin system (RAS) inhibitor prescription, proteinuria testing, and nonsteroidal anti-inflammatory drug (NSAID) avoidance. Each patient received an overall QI score (range: 0-3) based on the sum of the individual QI scores. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between QI scores and outcomes, including long-term dialysis, all-cause death, hospitalization for acute kidney injury (AKI), hyperkalemia, and acidosis. The study population had a mean age of 68.7 years and a female prevalence of 41.7%. Only 33.5% of patients received the highest QI score. During a median follow-up period of 23 months, higher overall QI scores were associated with lower risks of long-term dialysis (HR 0.891, 95% CI 0.846-0.938), all-cause death (HR 0.900, 95% CI 0.864-0.939), and acidosis (HR 0.882, 95% CI 0.799-0.972). Notably, the prescription of RAS inhibitors was consistently correlated with better outcomes. These findings underscore the importance of quality indicators, particularly the continued use of RAS inhibitors, in improving outcomes for nondiabetic CKD patients. Future research should focus on refining existing QIs and expanding their validation to broader populations and healthcare settings.
期刊介绍:
Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.