End-stage Renal Failure (ESRF) Clinical Trial
Official title:
Evaluation of Quality of Care - Haemodialysis Public-Private-Partnership, Hospital Authority (HA)
Patients with end-stage renal failure (ESRF) have lost the function to excrete urea and
maintain electrolyte balance, which is lethal unless they are given renal replacement therapy
(Gibney, Hoste et al. 2008). As one of the initiatives of service improvement, the HA has
introduced the haemodialysis public-private partnership (HD PPP) programme to shorten the
waiting time for patients with ESRF needing HD treatment. HD PPP programme is a new service
provision model that purchases healthcare services from non-Government healthcare
organizations. The evaluation on the quality of care (QOC) is an essential part of the
programme in order to inform future policy. The Department of Family Medicine and Primary
Care of the University of Hong Kong has been appointed by the HA to carry out the evaluation
of the QOC of the programme.
The Action Learning and Audit Spiral methodologies to measure whether the target standard of
care intended by the HD PPP programme is achieved. Each HD PPP participating hospitals and
centers will be invited to complete a structure evaluation questionnaire. Sixty patients who
have agreed to join HD PPP and 60 control patients who have refused to take part in HD PPP
will be included. The participants will be followed up by telephone to evaluate the effect of
the programme on quality of life (QOL), patient enablement, and global rating of change in
health condition. Data on the process of care and clinical outcomes of care will be retrieved
from the HA medical records.
Main Outcome Measures: The primary outcomes are the proportion of participants who have
received the planned process of care and adequate haemodialysis (HD) measured by the Kt/V
Data Analysis: Descriptive statistics on proportions meeting the QOC criteria will be
calculated. The outcomes of HD PPP subjects will be compared at 6, 12, 24, 36 and 48 months
by paired sample t-test. The outcomes between HD PPP subjects and control group will be
compared by independent sample t-test or Chi-square test.
Results: The QOC of the HD PPP programme will be determined. Areas of deficiency and possible
areas for quality enhancement will be identified.
Conclusion: The results of this study will provide empirical evidence on whether the HD PPP
can achieve equivalent QOC as the usual HA care in order to guide service planning and policy
decision making for patients with ESRF.
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