Link to: CPM Data
Link to: MRB Position Statement
Due to FDA advisories released in 2007 as well as new K-DOQI and CMS guidelines to avoid targeting hemoglobins over 12 g/dL, The Renal Network, Inc. has revised its anemia management goals. In past years, dialysis facilities were reviewed based on the percent of patients that had a hemoglobin measurement above 11.0 g/dL.
New reporting standards for anemia now present the percentage of patients below 10 g/dL, above 12 g/dL and within the range of 10-12 g/dL. The challenge has been to determine what percentage of patients is expected to fall within these targets.
Members of the Network's Medical Review Board determined expected hemoglobin rates based on facility size and population mean hemoglobin of 11.0g/dL using a statistical technique and actual Network hemoglobin data (see Table of Expected Hemoglobin Rates). This analysis provides a report of what we should realistically expect to see each month in the three hemoglobin ranges. The analysis could be used as a performance measure or a quality improvement tool by identifying what areas need to improve.
The Medical Review Board recommends that facilities track their monthly mean hemoglobin to ensure that this average is moving to the recommended target range. Failure of the mean hemoglobin to fall below 12 g/dL should prompt a review of the facility's anemia management protocol. Further, facilities should compare the observed percentage of patients in each of the three monitoring ranges to the expected percentage. It is likely that your facility will initially be out of range in several categories when making these comparisons as they are based on a population mean hemoglobin of 11.0 g/dL.
Facility goals should be to maximize the percent of patients within 10-12 g/dL while minimizing the percent of patients above 12.0 g/dL and below 10.0 g/dL. Periodic adjustment of the facility anemia management protocol will help you realize these goals over many months.